Provider Demographics
NPI:1457350696
Name:BROWN, MATTHEW GEORGE (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GEORGE
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 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-493-2511
Mailing Address - Fax:860-549-1476
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-493-2511
Practice Address - Fax:860-549-1476
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033654204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001336545Medicaid
CT020001351Medicare ID - Type Unspecified
CTE66594Medicare UPIN