Provider Demographics
NPI:1336281765
Name:BROWN, ROBERTA ELISE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ELISE
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 1:6865 HARPER DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5920
Mailing Address - Country:US
Mailing Address - Phone:440-357-5131
Mailing Address - Fax:
Practice Address - Street 1:8300 TYLER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4217
Practice Address - Country:US
Practice Address - Phone:440-205-1529
Practice Address - Fax:440-205-0840
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E86613Medicare UPIN