1770585721 NPI number — MARK G BROWN MD

Table of content: MARK G BROWN MD (NPI 1770585721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770585721 NPI number — MARK G BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MARK
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1770585721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 LIBERTY AVE STE 2000
Provider Second Line Business Mailing Address:
THREE GATEWAY CENTER, 20TH FLOOR
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15222-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-223-2272
Provider Business Mailing Address Fax Number:
412-281-6320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 BLAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-4227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-447-4065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2005

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: 2085R0202X , with the licence number:  MD072455L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 35.136171 , 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: 0018263370026 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00767228 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001826337-0024 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018263370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 131507 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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