Provider Demographics
NPI:1285642959
Name:BROWN, EVLYN (MD)
Entity Type:Individual
Prefix:
First Name:EVLYN
Middle Name:
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 1:592 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5539
Mailing Address - Country:US
Mailing Address - Phone:718-345-5000
Mailing Address - Fax:718-345-5794
Practice Address - Street 1:360 SNEDIKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4552
Practice Address - Country:US
Practice Address - Phone:646-459-9400
Practice Address - Fax:646-459-9455
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117067207Q00000X
NC2009-01964207Q00000X
NY226326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02410295Medicaid
NC5914336Medicaid
FL010394500Medicaid
FL14T22OtherFLORIDA BLUE
FLHR198ZMedicare PIN