Healthcare Provider Details

I. General information

NPI: 1043456510
Provider Name (Legal Business Name): DANIEL R BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 AVENUE LOUIS PASTEUR NRB-837
BOSTON MA
02115-5727
US

IV. Provider business mailing address

126 PARK ST #2
BROOKLINE MA
02446-4906
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-6570
  • Fax:
Mailing address:
  • Phone: 617-432-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number238737
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: