=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376679043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKS GIDEON BROWN III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5454 WISCONSIN AVE STE 1420
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-6961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-654-0767
-----------------------------------------------------
Fax | 301-654-0769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2661 RIVA RD STE 1030
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-7131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-571-8733
-----------------------------------------------------
Fax | 410-571-6309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D0015744
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------