Provider Demographics
NPI:1851381867
Name:BROWN, MATTHEW B (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:451 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2636
Practice Address - Country:US
Practice Address - Phone:607-733-3760
Practice Address - Fax:607-734-6000
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199781-11223S0112X
NY045766-11223S0112X
PADS030040L1223S0112X
NJ22DI019209001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27549Medicare UPIN
38183FMedicare ID - Type UnspecifiedCORNING, NY OFFICE
53025EMedicare ID - Type UnspecifiedWAVERLY, NY OFFICE
38182HMedicare ID - Type UnspecifiedELMIRA, NY OFFICE