Provider Demographics
NPI:1235257718
Name:BROWN, CHARLENE RENEE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:RENEE
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 1:1997 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3630
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:1643 NW 136TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3091
Practice Address - Country:US
Practice Address - Phone:888-447-2362
Practice Address - Fax:865-560-7110
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD587692084P0800X
PAMD4527362084P0800X
IL0361210682084P0804X
TXS68062084P0800X
FLME 978832084P0800X
VA01012708742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04515143OtherBCBS#
IL036-121068Medicaid
IL0727500001Medicare NSC
IL390361028Medicare PIN
IL390362028Medicare PIN