Provider Demographics
NPI:1558315440
Name:BROWN, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:67 PROSPECT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2907
Mailing Address - Country:US
Mailing Address - Phone:518-828-2566
Mailing Address - Fax:518-697-3403
Practice Address - Street 1:67 PROSPECT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2907
Practice Address - Country:US
Practice Address - Phone:518-828-2566
Practice Address - Fax:518-697-3403
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1-113905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000492901001OtherBS OF NENY
NY00770392Medicaid
050210000044OtherFIDELIS
10025345OtherCDPHP
2597780OtherGHI PPO
43082OtherGHI HMO
217331OtherMVP
92A713OtherBC/BS
1891975OtherUNITED HEALTHCARE
2597780OtherGHI PPO
1891975OtherUNITED HEALTHCARE
000492901001OtherBS OF NENY
92A713OtherBC/BS