1932168192 NPI number — DR. MARYALLYSON BROWN M.D.

Table of content: DR. MARYALLYSON BROWN M.D. (NPI 1932168192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932168192 NPI number — DR. MARYALLYSON BROWN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MARYALLYSON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1932168192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19456-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-482-4778
Provider Business Mailing Address Fax Number:
610-666-3310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 MEDICAL DR STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464-3279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-925-0500
Provider Business Practice Location Address Fax Number:
610-432-0545
Provider Enumeration Date:
03/17/2006

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: 207V00000X , with the licence number:  MD-068485-L , 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: 507297 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017521440009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0264802000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3942507 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0264802000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30022539 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G93641 . This is a "UPIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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