Provider Demographics
NPI:1649256306
Name:BROWN, ROBERT TIMOTHY (MD)
Entity type:Individual
Prefix:PROF
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R.
Other - Middle Name:TIMOTHY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-289-3375
Mailing Address - Fax:860-783-5733
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-6589
Practice Address - Fax:860-560-2849
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA555932085P0229X
CT0337242085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001337246Medicaid
CTA2516306OtherOXFORD
CT010033724CT01OtherANTHEM BC/BS
CTA2516306OtherOXFORD
CTF90903Medicare UPIN