Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | 2086S0127X | SC |
N | 2086S0129X | Vascular Surgeon | 2086S0129X | SC |
N | 2086X0206X | Surgical Oncologist | 2086X0206X | SC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 208G00000X | SC |
NPI | 1457954745 |
---|---|
Provider Name | Elena Dimitrievna Brown |
First Address | Greenville, SC 29601-3955 |
Second Address | Easley, SC 29640-9648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 18/11/2020 |