Provider Demographics
NPI:1548228026
Name:BROWN, JUSTIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3186
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3186
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00258207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC01151965OtherAMERIGROUP COMMUNITY CARE
MD401804400Medicaid
NC189766OtherMEDCOST
NC5193595OtherAETNA
SC80824OtherCHCCARES OF SC
SC20099589OtherSELECT HEALTH OF SC
NC5903896Medicaid
SCN58006Medicaid
NC5779672OtherCOVENTRY HEALTHCARE
NC142VWOtherBCBS NC
SC773868OtherWELLCARE
MDKR84G126Medicare ID - Type Unspecified
NC2053123Medicare PIN
SCP00329312Medicare PIN
SC01151965OtherAMERIGROUP COMMUNITY CARE