Provider Demographics
NPI:1366479388
Name:BROWN, SCOTT LAWRENCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3852
Mailing Address - Country:US
Mailing Address - Phone:203-852-3019
Mailing Address - Fax:203-899-5058
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:NORWALK HOSPITAL
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3852
Practice Address - Country:US
Practice Address - Phone:203-852-2375
Practice Address - Fax:203-855-3589
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S39206Medicare UPIN