Provider Demographics
NPI:1487645388
Name:TIMOTHY A BROWN MD PC
Entity Type:Organization
Organization Name:TIMOTHY A BROWN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-3090
Mailing Address - Street 1:2619 PENNSYLVANIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3777
Mailing Address - Country:US
Mailing Address - Phone:304-723-3090
Mailing Address - Fax:304-723-2576
Practice Address - Street 1:2619 PENNSYLVANIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-3090
Practice Address - Fax:304-723-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10935207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDG2133OtherRAILROAD MEDICARE
WV001941456OtherMOUNTAIN STATE BC BS
WVTI9369721OtherMEDICARE PTAN
WV3810009580Medicaid