Provider Demographics
NPI:1831170109
Name:BROWN, TODD B (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:B
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 THOMAS PL
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8350
Mailing Address - Country:US
Mailing Address - Phone:910-705-5213
Mailing Address - Fax:
Practice Address - Street 1:188 THOMAS PL
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8350
Practice Address - Country:US
Practice Address - Phone:910-705-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026140207P00000X
NC2009-00061207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524273Medicaid
AL051541689OtherBCBS
AL009935576Medicaid
AL051524273OtherBCBS PROVIDER NUMBER
AL009912367Medicaid
AL051532871OtherBCBS PROVIDER NUMBER
AL051524273Medicare PIN
AL051524273OtherBCBS PROVIDER NUMBER
AL009912367Medicaid
AL051559727Medicare PIN