Provider Demographics
NPI:1104379486
Name:BROWN, DYLAN ANTHONY
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:ANTHONY
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 MARSOL ROAD
Mailing Address - Street 2:APT. 442
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-413-7951
Mailing Address - Fax:
Practice Address - Street 1:6507 MARSOL RD
Practice Address - Street 2:APT. 442
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-3570
Practice Address - Country:US
Practice Address - Phone:440-142-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker