Healthcare Provider Details

I. General information

NPI: 1487603700
Provider Name (Legal Business Name): MARK S BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LAKE BOONE TRAIL SUITE 100
RALEIGH NC
27607-7529
US

IV. Provider business mailing address

4600 LAKE BOONE TRAIL SUITE 100
RALEIGH NC
27607-7529
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-1374
  • Fax: 919-571-8135
Mailing address:
  • Phone: 919-787-1374
  • Fax: 919-571-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35284
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: