Provider Demographics
NPI:1639384985
Name:BROWN, JOANNA KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:KRISTINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BROAD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6429
Mailing Address - Country:US
Mailing Address - Phone:440-328-3415
Mailing Address - Fax:216-201-6614
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE 219
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-326-5250
Practice Address - Fax:440-326-5255
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42061208600000X
OH35-096728208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3119799Medicaid
KY42061OtherMEDICAL LICENSE
KY9320Medicare PIN
OH4315301Medicare PIN
KY8011Medicare PIN
KY00692Medicare PIN
IN262320Medicare PIN
KY0989Medicare PIN