Basic Information
| Provider Information | |||||||||
| NPI: | 1457350696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 SEYMOUR ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604932511 | ||||||||
| FaxNumber: | 8605491476 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SEYMOUR ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604932511 | ||||||||
| FaxNumber: | 8605491476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 01/07/2010 | ||||||||
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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 | 204F00000X | 033654 | CT | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 033654 | CT | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 001336545 | 05 | CT | MEDICAID |