Healthcare Provider Details

I. General information

NPI: 1295846079
Provider Name (Legal Business Name): BETH BROWNLOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 POWDER MILL RD
CONCORD MA
01742-4808
US

IV. Provider business mailing address

414 POWDER MILL RD
CONCORD MA
01742-4808
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-3272
  • Fax: 978-369-4280
Mailing address:
  • Phone: 978-369-3272
  • Fax: 978-369-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number33131
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier26551
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 2
Identifier33131
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMEDICAL LICENSE
# 3
Identifier5391020
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA
# 4
Identifier265373000
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMAGELLAN
# 5
IdentifierM08409
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE SHIELD
# 6
Identifier002022
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerVALUE OPTIONS
# 7
Identifier717435
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 8
IdentifierAB6890087
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerD.E.A.

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: