Provider Demographics
NPI:1790437036
Name:BROWNRICHARDSON, ZAJE
Entity Type:Individual
Prefix:
First Name:ZAJE
Middle Name:
Last Name:BROWNRICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZAJE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:202 W BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3107
Practice Address - Country:US
Practice Address - Phone:484-401-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date: