1275517591 NPI number — LINDA G BROWN MD

Table of content: LINDA G BROWN MD (NPI 1275517591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275517591 NPI number — LINDA G BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
LINDA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275517591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE B510
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-3656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-691-8850
Provider Business Mailing Address Fax Number:
304-523-9470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE B510
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-3656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-691-8850
Provider Business Practice Location Address Fax Number:
304-523-9470
Provider Enumeration Date:
11/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  18422 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64941545 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2014635 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0103906000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".