Provider Demographics
NPI:1497753735
Name:BROWN ORTHOPAEDIC SURGERY & SPORTS MEDICINE CENTER, P.A.
Entity Type:Organization
Organization Name:BROWN ORTHOPAEDIC SURGERY & SPORTS MEDICINE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-891-2677
Mailing Address - Street 1:605 ATTAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1972
Mailing Address - Country:US
Mailing Address - Phone:919-561-3139
Mailing Address - Fax:919-557-9251
Practice Address - Street 1:605 ATTAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1972
Practice Address - Country:US
Practice Address - Phone:919-561-3139
Practice Address - Fax:919-557-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001043475207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013UVMedicaid
NC013UVOtherBC
NC2328140Medicare ID - Type Unspecified
NC89013UVMedicaid