Provider Demographics
NPI:1043765050
Name:BROWN, CHAUNCEY JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAUNCEY
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 N 5TH STREET
Mailing Address - Street 2:OFFICE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1825
Mailing Address - Country:US
Mailing Address - Phone:267-335-2647
Mailing Address - Fax:
Practice Address - Street 1:6001 N 5TH STREET
Practice Address - Street 2:OFFICE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1825
Practice Address - Country:US
Practice Address - Phone:267-335-2647
Practice Address - Fax:267-535-3086
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003215152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program