Provider Demographics
NPI:1952309726
Name:BROWN, INGRID M (DO)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-429-0607
Mailing Address - Fax:937-558-3067
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-429-0607
Practice Address - Fax:937-558-3067
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006519B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000066109OtherANTHEM
OH2032133Medicaid
OH2176908OtherAETNA
OH311346460032OtherCARESOURCE
OH110195587OtherRR MEDICARE
OH110195587OtherRR MEDICARE
OH0875941Medicare PIN