1942249214 NPI number — DR. PETER BROWN MD

Table of content: DR. PETER BROWN MD (NPI 1942249214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942249214 NPI number — DR. PETER BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1942249214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 196
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02018-0196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-585-9522
Provider Business Mailing Address Fax Number:
781-585-9544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 COLUMBIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02359-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-585-9522
Provider Business Practice Location Address Fax Number:
781-585-9544
Provider Enumeration Date:
06/05/2006

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: 207VX0000X , with the licence number:  72972 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 072970 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30601 . This is a "BOSTON MEDICAL HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 131578 . This is a "HARVARDPILGRIM HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3646367 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3125483 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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