Healthcare Provider Details

I. General information

NPI: 1700873387
Provider Name (Legal Business Name): NEIL MATTHEW BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23415 THREE NOTCH RD STE 2026
CALIFORNIA MD
20619-4021
US

IV. Provider business mailing address

23415 THREE NOTCH RD STE 2026
CALIFORNIA MD
20619-4021
US

V. Phone/Fax

Practice location:
  • Phone: 240-530-8188
  • Fax: 301-638-0470
Mailing address:
  • Phone: 301-530-8188
  • Fax: 301-638-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20600
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: