Healthcare Provider Details

I. General information

NPI: 1396729851
Provider Name (Legal Business Name): JACQUELINE C BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 E STATE ROAD 62 STE 2F
MADISON IN
47250-7328
US

IV. Provider business mailing address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4067
US

V. Phone/Fax

Practice location:
  • Phone: 812-801-0856
  • Fax: 812-801-0771
Mailing address:
  • Phone: 207-810-4985
  • Fax: 207-810-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number208945
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD17233
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01081390A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD23969
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60959358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: