Provider Demographics
NPI:1336132745
Name:BROWN, NATHANIEL F (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:F
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-0022
Mailing Address - Fax:617-696-1171
Practice Address - Street 1:1609 EGLIN ST
Practice Address - Street 2:HANSCOM AFB
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731-2613
Practice Address - Country:US
Practice Address - Phone:781-377-4740
Practice Address - Fax:781-274-8538
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA81312207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ31756OtherBLUE SHIELD
MA3147665Medicaid
MAP00392425Medicare PIN
MAA30437Medicare PIN
G03968Medicare UPIN
A20094Medicare ID - Type Unspecified