Provider Demographics
NPI:1154387181
Name:MAPLEWOOD OB-GYN PLLC
Entity type:Organization
Organization Name:MAPLEWOOD OB-GYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-2821
Mailing Address - Street 1:2830 MAPLEWOOD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4114
Mailing Address - Country:US
Mailing Address - Phone:336-760-2821
Mailing Address - Fax:336-760-1076
Practice Address - Street 1:2830 C MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-760-2821
Practice Address - Fax:336-760-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890278PMedicaid
202624DMedicare ID - Type Unspecified
NC890278PMedicaid