Provider Demographics
NPI:1679541429
Name:BROWN, RAYMOND E (PA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 BLAKENEY PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5713
Mailing Address - Country:US
Mailing Address - Phone:704-295-3311
Mailing Address - Fax:704-295-3322
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:704-295-3414
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
98459OtherMEDCOST
NC8103077Medicaid
4239461OtherAETNA POS
NC164XHOtherBCBSNC
98459OtherMEDCOST PREFERRED
SC1286PAMedicaid
NC7052304OtherAETNA
NC970011339OtherRAILROAD MEDICARE
4239461OtherAETNA PPO
NC2752642Medicare PIN
98459OtherMEDCOST PREFERRED