Provider Demographics
NPI:1689701674
Name:BROWN, REBECCA TYLER (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:TYLER
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 CENTRE ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1011
Mailing Address - Country:US
Mailing Address - Phone:617-363-8710
Mailing Address - Fax:617-363-8929
Practice Address - Street 1:1200 CENTRE ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1011
Practice Address - Country:US
Practice Address - Phone:617-363-8710
Practice Address - Fax:617-363-8929
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA235503207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine