Provider Demographics
NPI:1689745820
Name:BROWN, TERI G (MD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
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:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-801-2025
Mailing Address - Fax:704-801-2026
Practice Address - Street 1:9908 COULOAK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-8678
Practice Address - Country:US
Practice Address - Phone:704-801-2025
Practice Address - Fax:704-801-2026
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD33975208000000X
NC200800600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689745820Medicaid
SCNC2958Medicaid
NC5909448Medicaid
NC5909448Medicaid