Provider Demographics
NPI:1659317220
Name:BROWN, FREDRIC S (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:327 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1549
Mailing Address - Country:US
Mailing Address - Phone:570-961-5522
Mailing Address - Fax:570-207-5579
Practice Address - Street 1:440 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5500
Practice Address - Country:US
Practice Address - Phone:570-287-1122
Practice Address - Fax:570-207-5579
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024505E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007984990002Medicaid
042051Medicare ID - Type Unspecified
B96687Medicare UPIN