Provider Demographics
NPI:1679781363
Name:BROWN, MARTIN E (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:E
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-589-0802
Mailing Address - Fax:502-589-0805
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 510
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5705
Practice Address - Country:US
Practice Address - Phone:502-589-0802
Practice Address - Fax:502-589-0805
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY412792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100010930Medicaid
KY0050859Medicare PIN