Provider Demographics
NPI:1376588616
Name:BROWN, CHARLES I (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
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 1:59 PAGE HILL RD
Mailing Address - Street 2:AVH PATHOLOGY
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3531
Mailing Address - Country:US
Mailing Address - Phone:603-326-5756
Mailing Address - Fax:603-752-3709
Practice Address - Street 1:59 PAGE HILL RD
Practice Address - Street 2:AVH PATHOLOGY
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-326-5756
Practice Address - Fax:603-752-3709
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10895207ZP0102X
VT042-0010071207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE5684Medicaid
NH30200745Medicaid
VT0RE5684Medicaid
H14413Medicare UPIN
VTVN3118Medicare ID - Type Unspecified