Basic Information
| Provider Information | |||||||||
| NPI: | 1952392888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9135 | ||||||||
| Address2: | ATT:SHARON SILVA | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024469135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038939784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021155724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173557893 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 159958 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 208000000X | 159958 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | DB51503 | 05 | RI | MEDICAID | J26408 | 01 | MA | HMO BLUE | OTHER | 9938705 | 05 | AL | MEDICAID | AA9208 | 01 | MA | HARVARD PILGRIM | OTHER | 003122504 | 05 | CT | MEDICAID | 3253340 | 01 | MA | AETNA MA | OTHER | 26527 | 01 | MA | BMC HEALTHNET | OTHER | 2010364 | 05 | MA | MEDICAID | 97288101 | 01 | MA | NETWORK HEALTH | OTHER | 30204038 | 05 | NH | MEDICAID | J26408 | 01 | MA | BLUE CARE ELECT | OTHER | J26408 | 01 | MA | BCBS MA | OTHER | P00031693 | 01 | MA | RAILROAD MEDICARE | OTHER | 32294 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 159958 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 2490504 | 05 | NY | MEDICAID |