Basic Information
| Provider Information | |||||||||
| NPI: | 1427120922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITEHURST BROWN | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816467 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 4175 N HANSON CT | ||||||||
| Address2: | #209 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013524007 | ||||||||
| FaxNumber: | 3013523316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 12/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0039708 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 556331300 | 05 | MD | MEDICAID | 52061204 | 01 | BCBS MD RENDERING | OTHER | 4228811 | 01 | AETNA | OTHER | X99764 | 01 | MD UPIN | OTHER | Y8880002 | 01 | BCBS | OTHER |