Healthcare Provider Details

I. General information

NPI: 1205320926
Provider Name (Legal Business Name): ANDREW BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 QUINCY ST
BROCKTON MA
02302-2967
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 646
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2222
  • Fax:
Mailing address:
  • Phone: 585-275-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1019566
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: