Provider Demographics
NPI:1689700759
Name:BROOKS G. BROWN, III,M.D., P.A.
Entity Type:Organization
Organization Name:BROOKS G. BROWN, III,M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:GIDEON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:301-654-0767
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-654-0767
Mailing Address - Fax:301-656-2917
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1030
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-654-0767
Practice Address - Fax:301-656-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D18104Medicare UPIN
DC105234Medicare ID - Type Unspecified