Provider Demographics
NPI:1790700227
Name:BROWN, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-374-7720
Mailing Address - Fax:610-374-8852
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-374-7720
Practice Address - Fax:610-374-8852
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042962L208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0511233000OtherKEYSTONE HEALTH PLAN EAST
PA001288730001Medicaid
PA01143501OtherKEYSTONE SR. BLUE
PABR677678OtherHIGHMARK BLUE SHIELD
PA01143501OtherCAPITAL BLUE CROSS
PA5870040OtherAETNA
PA01143501OtherKEYSTONE HEALTH PLAN CENT
PA001288730001Medicaid
PA677678QUJMedicare ID - Type Unspecified