Provider Demographics
NPI:1578088431
Name:BROWN, SAVANNAH KAYLEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:KAYLEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WELTON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1336
Mailing Address - Country:US
Mailing Address - Phone:301-777-7900
Mailing Address - Fax:301-724-5590
Practice Address - Street 1:100 WELTON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-777-7900
Practice Address - Fax:301-724-5590
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006502363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty