Provider Demographics
NPI:1417053620
Name:BROWN, WILFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:
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 1:530 MIDDLEBURY RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2500
Mailing Address - Country:US
Mailing Address - Phone:203-758-2564
Mailing Address - Fax:203-758-2587
Practice Address - Street 1:530 MIDDLEBURY RD
Practice Address - Street 2:SUITE 201A
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2500
Practice Address - Country:US
Practice Address - Phone:203-758-2564
Practice Address - Fax:203-758-2587
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033266174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00133266800Medicaid
CTG93728Medicare UPIN
CT240000141Medicare Oscar/Certification
CT240000141Medicare ID - Type Unspecified