1639384985 NPI number — JOANNA KRISTINE BROWN MD

Table of content: JOANNA KRISTINE BROWN MD (NPI 1639384985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639384985 NPI number — JOANNA KRISTINE BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JOANNA
Provider Middle Name:
KRISTINE
Provider Name Prefix Text:
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:
1639384985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 E BROAD ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELYRIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44035-6429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-328-3415
Provider Business Mailing Address Fax Number:
216-201-6614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 219
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-326-5250
Provider Business Practice Location Address Fax Number:
440-326-5255
Provider Enumeration Date:
05/11/2007

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: 208600000X , with the licence number:  42061 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 35-096728 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3119799 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42061 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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