Provider Demographics
NPI:1457954745
Name:BROWN, ELENA DIMITRIEVNA (FIRST ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:DIMITRIEVNA
Last Name:BROWN
Suffix:
Gender:F
Credentials:FIRST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3955
Mailing Address - Country:US
Mailing Address - Phone:864-255-1073
Mailing Address - Fax:864-255-1929
Practice Address - Street 1:305 LENA DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-9648
Practice Address - Country:US
Practice Address - Phone:678-559-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2086S0129X2086S0129X
SC2086H0002X2086H0002X
SC2086X0206X2086X0206X
SC2088F0040X2088F0040X
SC208G00000X208G00000X
SC2086S0127X2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)