Provider Demographics
NPI:1467566604
Name:BROWN, VANCE M (MD)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:M
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 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:SUITE 2C
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7163
Practice Address - Country:US
Practice Address - Phone:207-883-7926
Practice Address - Fax:207-883-1925
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077106B207Q00000X
MEMD18087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2135497Medicaid
ME001563302Medicare PIN
OHBR7345571Medicare PIN
OHF41485Medicare UPIN
ME001563303Medicare PIN
MEP01010595Medicare PIN
ME001563301Medicare PIN
ME001563304Medicare PIN