Healthcare Provider Details

I. General information

NPI: 1942521125
Provider Name (Legal Business Name): TIMOTHY B BROWN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LIBBY ST
BROCKTON MA
02302-2949
US

IV. Provider business mailing address

25 LIBBY ST
BROCKTON MA
02302-2949
US

V. Phone/Fax

Practice location:
  • Phone: 844-604-4673
  • Fax: 508-894-0772
Mailing address:
  • Phone: 844-604-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD459807
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-244074
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number261364
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: