Provider Demographics
NPI:1740811090
Name:BROWN, JAMAL T I
Entity type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:T
Last Name:BROWN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 M ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-5176
Mailing Address - Country:US
Mailing Address - Phone:202-291-0754
Mailing Address - Fax:
Practice Address - Street 1:1221 M ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5176
Practice Address - Country:US
Practice Address - Phone:202-291-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC57915508Medicaid