Provider Demographics
NPI:1376569202
Name:BROWN, CHRISTOPHER COLES (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:COLES
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 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4300
Mailing Address - Fax:
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:STE #B3
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-284-1808
Practice Address - Fax:401-284-1810
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11957207R00000X, 208M00000X
CT043365207R00000X
WY5301A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI311984OtherBLUE CROSS BLUE SHIELD
RI413098OtherBLUE CROSS BLUE SHIELD
RI7058289Medicaid
RI7058289Medicaid