Provider Demographics
NPI:1275143919
Name:BROWN, MILTON MCINTYRE IV (IDC)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:MCINTYRE
Last Name:BROWN
Suffix:IV
Gender:M
Credentials:IDC
Other - Prefix:MR
Other - First Name:TY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:12610 CHANLER LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1302
Mailing Address - Country:US
Mailing Address - Phone:703-750-2092
Mailing Address - Fax:
Practice Address - Street 1:12610 CHANLER LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1302
Practice Address - Country:US
Practice Address - Phone:703-750-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty