Provider Demographics
NPI:1356309546
Name:BROWN, GARY C (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 BUTLER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1560
Mailing Address - Country:US
Mailing Address - Phone:267-420-1375
Mailing Address - Fax:
Practice Address - Street 1:4060 BUTLER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1560
Practice Address - Country:US
Practice Address - Phone:800-331-6634
Practice Address - Fax:267-420-1360
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018669E207W00000X
NJMA39672207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007928600001Medicaid
NJ488957905JMedicaid
NJ603625AHDMedicare PIN
PA0007928600001Medicaid
PA116438EV6Medicare PIN
NJ603625Medicare ID - Type UnspecifiedNJ MEDICARE
PA116438Medicare ID - Type UnspecifiedPA MEDICARE