1326020660 NPI number — DR. DIANA BROWN MD

Table of content: DR. DIANA BROWN MD (NPI 1326020660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326020660 NPI number — DR. DIANA BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
DIANA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326020660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 FLOURTOWN AVE
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
WYNDMOOR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19038-7976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-233-0506
Provider Business Mailing Address Fax Number:
215-233-3288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 FLOURTOWN AVE
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
WYNDMOOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-7976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-233-0506
Provider Business Practice Location Address Fax Number:
215-233-3288
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD023816E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4061583 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0466840000 . This is a "PENS CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P2659600 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0466840000 . This is a "KEYSTON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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