MEDICARE: TEVIN ALEXANDER BROWN MD

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	106S00000X	Behavior Technician		OH
2	103K00000X	Behavior Analyst	12365844	OH

General Provider Information

NPI Number	:	1891303301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEVIN ALEXANDER BROWN MD

Provider Business Mailing Address
First Line	:	3296 WESTERVILLE RD UNIT 469
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3790
Country	:	US
Telephone Number	:	614-214-3793
Fax Number	:

Provider Business Practice Location Address
First Line	:	3296 WESTERVILLE RD UNIT 469
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3790
Country	:	US
Telephone Number	:	614-214-3793
Fax Number	:

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

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	07/07/2023

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