Provider Demographics
NPI:1710168711
Name:BROWN, LAUREN W (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:W
Other - Last Name:FULLERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:877-660-6777
Mailing Address - Fax:412-359-8055
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:877-660-6777
Practice Address - Fax:412-359-8055
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053095363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119138NH3Medicare PIN