Provider Demographics
NPI:1205037470
Name:BROWN, TY (MD)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-957-0052
Mailing Address - Fax:859-957-0054
Practice Address - Street 1:2670 CHANCELLOR DRIVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5466
Practice Address - Country:US
Practice Address - Phone:859-957-0052
Practice Address - Fax:859-957-0054
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY414712084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201206690Medicaid
KY7100039290Medicaid
KYP00935634OtherRAILROAD MEDICARE
IN201206690Medicaid