Healthcare Provider Details

I. General information

NPI: 1770933137
Provider Name (Legal Business Name): JOSHUA BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

1580 MASSACHUSETTS AVE APT 3C
CAMBRIDGE MA
02138-2910
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number267166
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number283218
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: