Provider Demographics
NPI:1417128570
Name:BROWN, LORI MARIE (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
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 1:2000 OXFORD DR STE 440
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1841
Mailing Address - Country:US
Mailing Address - Phone:724-299-1513
Mailing Address - Fax:724-605-3885
Practice Address - Street 1:2000 OXFORD DR STE 440
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1841
Practice Address - Country:US
Practice Address - Phone:724-299-1513
Practice Address - Fax:724-605-3885
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014702207R00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102340971Medicaid
PA161743Medicare PIN