Provider Demographics
NPI:1467491050
Name:BROWN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:826 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-933-8484
Mailing Address - Fax:610-917-0320
Practice Address - Street 1:826 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-933-8484
Practice Address - Fax:610-917-0320
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033335E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010573760006Medicaid
PA0010573760006Medicaid
PAD71389Medicare UPIN