Provider Demographics
NPI:1568469641
Name:BROWN, MARTIN TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:TODD
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 1:2325 ABERDEEN BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0614
Mailing Address - Country:US
Mailing Address - Phone:704-853-3937
Mailing Address - Fax:704-853-0840
Practice Address - Street 1:2325 ABERDEEN BLVD
Practice Address - Street 2:STE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0614
Practice Address - Country:US
Practice Address - Phone:704-853-3937
Practice Address - Fax:704-853-0840
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38591207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA0653OtherMEDCOST
NC1057NOtherBLUE CROSS OF NC
NC4797OtherPARTNERS MEDICARE CHOICE
NC891057NMedicaid
NC1577Medicare PIN
NC891057NMedicaid