Healthcare Provider Details

I. General information

NPI: 1184792194
Provider Name (Legal Business Name): SYD BROWN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SUMMIT AVENUE
KENSINGTON MD
20895
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 WEST
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2384
  • Fax: 301-897-2380
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01164
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number01664
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: