=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689700759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOKS G. BROWN, III,M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5454 WISCONSIN AVE SUITE 1030
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-6901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-654-0767
-----------------------------------------------------
Fax | 301-656-2917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5454 WISCONSIN AVE SUITE 1030
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-6901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-654-0767
-----------------------------------------------------
Fax | 301-656-2917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BROOKS GIDEON BROWN III
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-654-0767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D0015744
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------