Provider Demographics
NPI:1700873387
Name:BROWN, NEIL MATTHEW
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:MATTHEW
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23415 THREE NOTCH RD STE 2026
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4021
Mailing Address - Country:US
Mailing Address - Phone:301-530-8188
Mailing Address - Fax:301-638-0470
Practice Address - Street 1:23415 THREE NOTCH RD STE 2026
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-4021
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:301-638-0470
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376550400Medicaid