Provider Demographics
NPI:1922045038
Name:BROWN, VASUMATHI KEITH (MD, LADC-1)
Entity Type:Individual
Prefix:DR
First Name:VASUMATHI
Middle Name:KEITH
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD, LADC-1
Other - Prefix:DR
Other - First Name:VASUMATHI
Other - Middle Name:
Other - Last Name:GOVINDARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2308 S HOPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4727
Mailing Address - Country:US
Mailing Address - Phone:978-219-9049
Mailing Address - Fax:888-488-2940
Practice Address - Street 1:49 CENTRAL ST STE UNITB
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2103
Practice Address - Country:US
Practice Address - Phone:978-710-9877
Practice Address - Fax:888-488-2940
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16721101YA0400X
MA207994202C00000X, 208M00000X, 207QA0401X, 2084A0401X, 208VP0014X, 208D00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
J28547OtherBLUE CROSS BLUE SHIELD
MA2025710Medicaid
AA38478OtherHARVARD PILGRIM HEALTH CA
MAP00716212OtherRAILROAD MEDICARE
MA2025710Medicaid
AA38478OtherHARVARD PILGRIM HEALTH CA
MAA2146003Medicare PIN