Provider Demographics
NPI:1164717955
Name:BROWN, KIMBERLY C (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LEWIS AVE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451
Mailing Address - Country:US
Mailing Address - Phone:203-694-8566
Mailing Address - Fax:
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2101
Practice Address - Country:US
Practice Address - Phone:203-694-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.053374207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program