Basic Information
| Provider Information | |||||||||
| NPI: | 1336132745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HIGHLAND ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021863881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176960022 | ||||||||
| FaxNumber: | 6176961171 | ||||||||
| Practice Location | |||||||||
| Address1: | 1609 EGLIN ST | ||||||||
| Address2: | HANSCOM AFB | ||||||||
| City: | HANSCOM AFB | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017312613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813774740 | ||||||||
| FaxNumber: | 7812748538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 81312 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 81312 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | J31756 | 01 | MA | BLUE SHIELD | OTHER | 3147665 | 05 | MA | MEDICAID |