Provider Demographics
NPI:1538328414
Name:CALVIN R. BROWN, MD, INC
Entity Type:Organization
Organization Name:CALVIN R. BROWN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-867-9408
Mailing Address - Street 1:1655 W MARKET ST
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2834928Medicaid
OHA77613Medicare UPIN
OH0447782Medicare PIN