Provider Demographics
NPI:1932136082
Name:BROWN, REGINA BETH (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:BETH
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 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-2273
Mailing Address - Fax:814-333-5925
Practice Address - Street 1:1009 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3465
Practice Address - Country:US
Practice Address - Phone:814-337-2273
Practice Address - Fax:814-333-5925
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1974517OtherHIGHMARK BLUE SHIELD
PA1019643540001Medicaid
PA1019643540001Medicaid
PA1974517OtherHIGHMARK BLUE SHIELD