Provider Demographics
NPI:1326020660
Name:BROWN, DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 FLOURTOWN AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7976
Mailing Address - Country:US
Mailing Address - Phone:215-233-0506
Mailing Address - Fax:215-233-3288
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-233-0506
Practice Address - Fax:215-233-3288
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023816E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4061583OtherAETNA
PA0466840000OtherPENS CHOICE
P2659600OtherOXFORD
PA0466840000OtherKEYSTON
PA424383Medicare PIN
P2659600OtherOXFORD