1508820119 NPI number — MICHAEL J BROWN PA

Table of content: MICHAEL J BROWN PA (NPI 1508820119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508820119 NPI number — MICHAEL J BROWN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

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:
1508820119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1815 CLINTON AVE S
Provider Second Line Business Mailing Address:
STE 530
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-5721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-442-4310
Provider Business Mailing Address Fax Number:
585-442-6750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WHITE SPRUCE BLVD
Provider Second Line Business Practice Location Address:
DERMATOLOGY ASSOCIATES OF ROCHESTER PC
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-272-0700
Provider Business Practice Location Address Fax Number:
585-697-0822
Provider Enumeration Date:
04/12/2006

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 000051 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BB2718 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".