Healthcare Provider Details

I. General information

NPI: 1942249214
Provider Name (Legal Business Name): PETER BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COLUMBIA RD
PEMBROKE MA
02359-1841
US

IV. Provider business mailing address

PO BOX 196
ACCORD MA
02018-0196
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-9522
  • Fax: 781-585-9544
Mailing address:
  • Phone: 781-585-9522
  • Fax: 781-585-9544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number72972
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: