Provider Demographics
NPI:1225294176
Name:BROWN, DARCI LAVONNE (DO)
Entity Type:Individual
Prefix:DR
First Name:DARCI
Middle Name:LAVONNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CHANNINGWAY DR STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9252
Mailing Address - Country:US
Mailing Address - Phone:937-878-8645
Mailing Address - Fax:937-878-8646
Practice Address - Street 1:1045 CHANNINGWAY DR STE A
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-9252
Practice Address - Country:US
Practice Address - Phone:937-878-8644
Practice Address - Fax:937-878-8646
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019618207Q00000X
OH34010291207Q00000X
OH58.002536390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055062Medicaid
OH0055062Medicaid
OHH037192Medicare PIN