Provider Demographics
NPI:1417081803
Name:BROWN, LOUIS ALFRED JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ALFRED
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6326 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5630
Mailing Address - Country:US
Mailing Address - Phone:215-745-9794
Mailing Address - Fax:215-745-3775
Practice Address - Street 1:6326 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5630
Practice Address - Country:US
Practice Address - Phone:215-745-9794
Practice Address - Fax:215-745-3775
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 032402-E207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001070126Medicaid
PA001070126Medicaid
PA159926Medicare ID - Type Unspecified