Provider Demographics
NPI:1568755627
Name:BROWN, JULIA R (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EAST STATE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-565-2776
Mailing Address - Fax:610-656-4247
Practice Address - Street 1:200 E STATE ST STE 205
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-565-2776
Practice Address - Fax:610-565-4247
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054406363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
238134XDKMedicare PIN