Basic Information
| Provider Information | |||||||||
| NPI: | 1407888563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BROWN VANNOZ | ||||||||
| OtherFirstName: | DENISE | ||||||||
| OtherMiddleName: | RENEE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502350 | ||||||||
| FaxNumber: | 5083502318 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COMPASS WAY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502300 | ||||||||
| FaxNumber: | 5083502310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 217496 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2012308 | 05 | MA | MEDICAID | 217496 | 01 | MA | TAHP | OTHER | 714576 | 01 | MA | HPHC | OTHER | J26331 | 01 | MA | BC/BS | OTHER |