Provider Demographics
NPI:1205858610
Name:BROWN-HARRISON, MARY CAROLE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLE
Last Name:BROWN-HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FL, MSC9152
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138798OtherBCMH
OH000000189644OtherANTHEM
OH2138798Medicaid
OH000000525911OtherANTHEM
OH363383OtherWELLCARE
OH000000221121OtherUNISON
PA1021101760001OtherPA MEDICAID
OH2467730OtherAETNA
OH738037OtherBUCKEYE
OH000000221121OtherUNISON
OH2467730OtherAETNA
OH2138798OtherBCMH