Provider Demographics
NPI:1124133657
Name:BROWN, DANIEL EDWARD (DPM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DESMOND AVE
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1355
Mailing Address - Country:US
Mailing Address - Phone:774-239-4534
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 208 - PEABODY PODIATRY
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2904
Practice Address - Country:US
Practice Address - Phone:978-531-9969
Practice Address - Fax:978-531-3745
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2215213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0708143Medicaid
MA0708143Medicaid
MABRY75153Medicare ID - Type Unspecified