Provider Demographics
NPI:1104868116
Name:BROWN, DAVID S
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BEACON ST
Mailing Address - Street 2:OFFICE #16
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4808
Mailing Address - Country:US
Mailing Address - Phone:617-738-7800
Mailing Address - Fax:617-738-7815
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:OFFICE #16
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-738-7800
Practice Address - Fax:617-738-7815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32640174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACO4607Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER