Healthcare Provider Details

I. General information

NPI: 1891303301
Provider Name (Legal Business Name): TEVIN ALEXANDER BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3296 WESTERVILLE RD UNIT 469
COLUMBUS OH
43224-3790
US

IV. Provider business mailing address

3296 WESTERVILLE RD UNIT 469
COLUMBUS OH
43224-3790
US

V. Phone/Fax

Practice location:
  • Phone: 614-214-3793
  • Fax:
Mailing address:
  • Phone: 614-214-3793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12365844
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: