Provider Demographics
NPI:1104995133
Name:BROWN, ROBERT HARRIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRIS
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEWBURY PARK
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4218
Mailing Address - Country:US
Mailing Address - Phone:781-444-9352
Mailing Address - Fax:
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-783-7100
Practice Address - Fax:617-783-7104
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59575207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3044459Medicaid
MAD87956Medicare UPIN
MAJ08159Medicare ID - Type Unspecified