Provider Demographics
NPI:1073650495
Name:BROWN, JENNIFER MAZE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MAZE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:MAZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27907-0189
Mailing Address - Country:US
Mailing Address - Phone:252-338-4400
Mailing Address - Fax:
Practice Address - Street 1:711 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5643
Practice Address - Country:US
Practice Address - Phone:252-338-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19127OtherBLUE CROSS BLUE SHIELD
NC89-19127Medicaid
NC19127OtherBLUE CROSS BLUE SHIELD