1518940733 NPI number — LINDA L BROWN MD

Table of content: LINDA L BROWN MD (NPI 1518940733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518940733 NPI number — LINDA L BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
LINDA
Provider Middle Name:
L
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:
1518940733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02940-9484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-854-2504
Provider Business Mailing Address Fax Number:
401-854-2519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
593 EDDY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-4000
Provider Business Practice Location Address Fax Number:
401-427-7795
Provider Enumeration Date:
11/22/2005

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: 207PP0204X , with the licence number:  MD12321 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD12321 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: MD12321 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007059280 . This is a "MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 939025129 . This is a "RI MEDICARE GROUP NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 12/29/2008 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 001424340 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 414116 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 06/14/2007 . This is a "NHPRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: LB69165 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".