Provider Demographics
NPI:1831136555
Name:BROWN, WAYNE D (MD, MSC, MPH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD, MSC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 BEDFORD ST
Mailing Address - Street 2:SUITE 18A
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-863-8080
Mailing Address - Fax:781-863-8081
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:18A LEXINGTON MED MANAGEMENT
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-863-8080
Practice Address - Fax:781-863-8081
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD99824Medicare UPIN