Provider Demographics
NPI:1366530768
Name:BROWN, TERESA LYNN (DO)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:648-512-5783
Mailing Address - Fax:864-646-3377
Practice Address - Street 1:1005 MEEHAN WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-1860
Practice Address - Country:US
Practice Address - Phone:864-512-5783
Practice Address - Fax:864-646-3377
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC51284207Q00000X
IA3482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMEDICAIDOther512840
IA238927OtherMIDLANDS CHOICE
IA481295570OtherTRICARE WPS
IAI8825OtherSTERLING OPTION 1
IA082266OtherHEALTH ALLIANCE
IA101043OtherHEALTH PARTNERS
IA1279240Medicaid
IA2036275OtherUNITED HEALTHCARE
IA481295570OtherFIRST ADMINISTRATORS
IAIA0101OtherJOHN DEERE
IA33359OtherBLUE CROSS BLUE SHIELD
IAI8825Medicare PIN
IAI8825OtherSTERLING OPTION 1