Healthcare Provider Details

I. General information

NPI: 1013830355
Provider Name (Legal Business Name): JEREMIAH DANIEL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 307E
BEVERLY MA
01915-6107
US

IV. Provider business mailing address

9 PLEASANT AVE
DANVERS MA
01923-3615
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-2280
  • Fax:
Mailing address:
  • Phone: 978-394-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: