Provider Demographics
NPI:1285686766
Name:BROWN, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
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:PO BOX 6247
Mailing Address - Street 2:
Mailing Address - City:SNOWMASS VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:81615-6247
Mailing Address - Country:US
Mailing Address - Phone:843-816-4549
Mailing Address - Fax:
Practice Address - Street 1:1326 EISENHOWER DR BLDG 1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-691-4200
Practice Address - Fax:912-303-3506
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC191652085R0202X
CO480812085R0202X
GA0285092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025709000Medicaid
GA52237053005OtherBCBS
COCO305926OtherMEDICARE RIA
KS200627500AMedicaid
CO85588555Medicaid
MT1285686766Medicaid
NE84059792913Medicaid
WY1285686766Medicaid
GAN355708OtherWELLCARE
P00347630OtherRR MEDICARE
GA000321087GMedicaid
AZ474618Medicaid
NM47706252Medicaid
NE84089712600Medicaid
COCO305925OtherMEDICARE MIC
COP00760022OtherRR MCR MIC
NENA1215049Medicare PIN
GA30BDMPHMedicare PIN
GA52237053005OtherBCBS
NE84089712600Medicaid
GAN355708OtherWELLCARE