Provider Demographics
NPI:1073940904
Name:MICHELE D. BROWN, M.D., LLC
Entity Type:Organization
Organization Name:MICHELE D. BROWN, M.D., LLC
Other - Org Name:MICHELE D BROWN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:DORY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-353-1446
Mailing Address - Street 1:53 OLD KINGS HWY N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4735
Mailing Address - Country:US
Mailing Address - Phone:203-353-1446
Mailing Address - Fax:203-323-0079
Practice Address - Street 1:53 OLD KINGS HWY N
Practice Address - Street 2:SUITE 201
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4735
Practice Address - Country:US
Practice Address - Phone:203-353-1446
Practice Address - Fax:203-323-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024216207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001242164Medicaid
CT001242164Medicaid