MEDICARE: MICHAEL WAYNE BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN1857254	MA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1528428976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WAYNE BROWN

Provider Business Mailing Address
First Line	:	1395 N MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-1768
Country	:	US
Telephone Number	:	781-963-6077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 N MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-1768
Country	:	US
Telephone Number	:	781-963-6077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2016
Last Update Date	:	03/29/2017

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Directions to “ MICHAEL WAYNE BROWN ” Practice Location

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