Provider Demographics
NPI:1861918435
Name:BROWN, RYAN LEIGH (MED)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEIGH
Last Name:BROWN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 SUPERIOR LN STE A6
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1939
Mailing Address - Country:US
Mailing Address - Phone:301-464-5129
Mailing Address - Fax:240-718-1700
Practice Address - Street 1:3231 SUPERIOR LANE
Practice Address - Street 2:SUITE, A6
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-464-5129
Practice Address - Fax:240-718-1700
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD55-3344103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool