Provider Demographics
NPI:1053456566
Name:BROWN, KISHA PERKINS (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHA
Middle Name:PERKINS
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KISHA
Other - Middle Name:AILEEN
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12505 DORSEY LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5374
Mailing Address - Country:US
Mailing Address - Phone:301-868-4446
Mailing Address - Fax:
Practice Address - Street 1:12505 DORSEY LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5374
Practice Address - Country:US
Practice Address - Phone:301-868-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP17503208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444PMedicare PIN