Provider Demographics
NPI:1679611909
Name:BROWNWORTH, NILS M (PA)
Entity Type:Individual
Prefix:MR
First Name:NILS
Middle Name:M
Last Name:BROWNWORTH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19851 OBSERVATION DR
Mailing Address - Street 2:STE 250
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4139
Mailing Address - Country:US
Mailing Address - Phone:301-972-0400
Mailing Address - Fax:301-916-1453
Practice Address - Street 1:20412 SUNBRIGHT LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1087
Practice Address - Country:US
Practice Address - Phone:301-972-0400
Practice Address - Fax:301-916-1453
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002533363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPA56895OtherCDS
MDMB1125803OtherDEA