Provider Demographics
NPI:1558984237
Name:CIAVAGLIA-BROWN, ADDISON LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:LYNN
Last Name:CIAVAGLIA-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W MEDICAL CENTER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4233
Mailing Address - Country:US
Mailing Address - Phone:281-486-7900
Mailing Address - Fax:
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4233
Practice Address - Country:US
Practice Address - Phone:281-486-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU6700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALSTUDENTOtherSTUDENT