1285069351 NPI number — TERESA L BROWN

Table of content: TERESA L BROWN (NPI 1285069351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285069351 NPI number — TERESA L BROWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
TERESA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1285069351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3920 WORRILOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKHAVEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19015-1917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-871-1394
Provider Business Mailing Address Fax Number:
610-933-4080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1288 VALLEY FORGE RD
Provider Second Line Business Practice Location Address:
UNIT 69
Provider Business Practice Location Address City Name:
PHOENIXVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19460-2687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-933-9483
Provider Business Practice Location Address Fax Number:
610-933-4080
Provider Enumeration Date:
09/09/2013

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: 164W00000X , with the licence number:  PN293717 , 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)