Healthcare Provider Details

I. General information

NPI: 1013075936
Provider Name (Legal Business Name): CARL THEODORE BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARL T BROWN MD

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 METRO CENTER DR KAISER PERMANENTE RESTON MEDICAL CENTER
RESTON VA
20190-5286
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-709-1500
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101044886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: