Provider Demographics
NPI:1093724403
Name:BROWN, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:335 GLESSNER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2269
Mailing Address - Country:US
Mailing Address - Phone:419-522-0320
Mailing Address - Fax:419-522-0350
Practice Address - Street 1:770 BALGREEN DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4106
Practice Address - Country:US
Practice Address - Phone:419-522-0320
Practice Address - Fax:419-522-0350
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.063708207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000560101OtherANTHEM
OH000000231130OtherANTHEM
OH000000240080OtherUNISON
OH0261694Medicaid
OH000000240080OtherUNISON
OH000000231130OtherANTHEM
OHF90483Medicare UPIN