=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366594913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CURTLAND CHESTER BROWN III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MERIDEN AVE SUITE 1H
-----------------------------------------------------
City | SOUTHINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06489-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-621-0555
-----------------------------------------------------
Fax | 860-621-8325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 MERIDEN AVE SUITE 1H
-----------------------------------------------------
City | SOUTHINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06489-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-621-0555
-----------------------------------------------------
Fax | 860-621-8325
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 027898
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------