Provider Demographics
NPI:1619563251
Name:BROWN, PATRICK
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 JEFFERSON ST S
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-2084
Mailing Address - Country:US
Mailing Address - Phone:304-645-0057
Mailing Address - Fax:304-645-0077
Practice Address - Street 1:765 JEFFERSON ST S
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-2084
Practice Address - Country:US
Practice Address - Phone:304-645-0057
Practice Address - Fax:304-645-0077
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024363Medicaid