Provider Demographics
NPI:1477554731
Name:BROWN, ANDREA E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3646
Mailing Address - Fax:215-707-3644
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-3646
Practice Address - Fax:215-707-3644
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044029E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1114548OtherKEYSTONE MERCY
PAPA12734OtherQUALMED
PA0360998000OtherKEYSTONE AMOR HEALTH
PA1168446Medicaid
PA2323776OtherAETNA US HEALTH
PA2Y6170OtherPHS HEALTH PLAN
157681MD044029EOtherHEALTH PARTNERS
PAPA12734OtherQUALMED
PA1168446Medicaid