Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101044886 | VA |
NPI | 1013075936 |
---|---|
Provider Name | Dr. Carl Theodore Brown |
First Address | Rockville, MD 20852-4908 |
Second Address | Reston, VA 20190-5286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 12/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C02136 | (02) |