Provider Demographics
NPI:1396780359
Name:BROWN, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-368-3031
Mailing Address - Fax:585-368-3037
Practice Address - Street 1:55 GENESEE ST
Practice Address - Street 2:BISHOP KEARNEY BUILDING, 3RD FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3031
Practice Address - Fax:585-368-3037
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01518964OtherMEDICARE RR
NY02676511Medicaid
NYRA7790- GRP 70008AMedicare PIN
NY02676511Medicaid
NY02676511Medicaid