Provider Demographics
NPI:1508820119
Name:BROWN, MICHAEL J (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1815 CLINTON AVE S
Mailing Address - Street 2:STE 530
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5721
Mailing Address - Country:US
Mailing Address - Phone:585-442-4310
Mailing Address - Fax:585-442-6750
Practice Address - Street 1:100 WHITE SPRUCE BLVD
Practice Address - Street 2:DERMATOLOGY ASSOCIATES OF ROCHESTER PC
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1507
Practice Address - Country:US
Practice Address - Phone:585-272-0700
Practice Address - Fax:585-697-0822
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY000051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB2718Medicaid
BB2718Medicare ID - Type Unspecified