Provider Demographics
NPI:1508868472
Name:BROWN, CALVIN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:RICHARD
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 1:1655 W MARKET ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7004
Mailing Address - Country:US
Mailing Address - Phone:330-867-9408
Mailing Address - Fax:330-867-3457
Practice Address - Street 1:1655 W MARKET ST
Practice Address - Street 2:SUITE L
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7004
Practice Address - Country:US
Practice Address - Phone:330-867-9408
Practice Address - Fax:330-867-3457
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-03-21
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
OH35041051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0424697Medicaid
OH0447782Medicare PIN
OHA77613Medicare UPIN