Healthcare Provider Details

I. General information

NPI: 1093192825
Provider Name (Legal Business Name): MATTHEW EVAN BROWN P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER STREET
PAWTUCKET RI
02860
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2304
  • Fax: 401-729-2923
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01043
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: