1548228026 NPI number — DR. JUSTIN C BROWN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548228026 NPI number — DR. JUSTIN C BROWN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BROWN

Provider First Name:

JUSTIN

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1548228026

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/26/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6035 FAIRVIEW RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHARLOTTE

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

28210-3256

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

704-295-3000

Provider Business Mailing Address Fax Number:

704-295-3186

Provider First Line Business Practice Location Address:

6035 FAIRVIEW RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHARLOTTE

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28210-3256

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

704-295-3000

Provider Business Practice Location Address Fax Number:

704-295-3186

Provider Enumeration Date:

05/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207WX0107X , with the licence number:  2006-00258 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207W00000X , with the licence number: 2006-00258 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01151965 . This is a "AMERIGROUP COMMUNITY CARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 401804400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 189766 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 5193595 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 80824 . This is a "CHCCARES OF SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 20099589 . This is a "SELECT HEALTH OF SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 5903896 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: N58006 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 5779672 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 142VW . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 773868 . This is a "WELLCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".