1598965626 NPI number — MISS MARY D BROWN MS, RD, LDN

Table of content: MISS MARY D BROWN MS, RD, LDN (NPI 1598965626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598965626 NPI number — MISS MARY D BROWN MS, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MARY
Provider Middle Name:
D
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LDN
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:
1598965626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1313 SPRINGMIST DR
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:
28262-3281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-999-0880
Provider Business Mailing Address Fax Number:
877-385-9026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2102 SOUTH BLVD
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-999-0880
Provider Business Practice Location Address Fax Number:
877-385-9026
Provider Enumeration Date:
07/18/2007

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: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: L003052 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133VN1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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