Provider Demographics
NPI:1548232853
Name:BROWN, MADDALENA DEROSA (MD)
Entity type:Individual
Prefix:
First Name:MADDALENA
Middle Name:DEROSA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADDALENA
Other - Middle Name:
Other - Last Name:DEROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3975 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9715
Mailing Address - Country:US
Mailing Address - Phone:828-466-0466
Mailing Address - Fax:828-466-8862
Practice Address - Street 1:3975 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-9715
Practice Address - Country:US
Practice Address - Phone:828-466-0466
Practice Address - Fax:828-466-8862
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40093207R00000X
NC2017-00228207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110009644Medicare ID - Type Unspecified