Provider Demographics
NPI:1013075936
Name:BROWN, CARL THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:THEODORE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:T
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:1890 METRO CENTER DR
Practice Address - Street 2:KAISER PERMANENTE RESTON MEDICAL CENTER
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5286
Practice Address - Country:US
Practice Address - Phone:703-709-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044886207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
014470K92Medicare ID - Type Unspecified
C02136Medicare UPIN