Provider Demographics
NPI:1245010859
Name:JOSEPH BROWN, KERITZA
Entity type:Individual
Prefix:
First Name:KERITZA
Middle Name:
Last Name:JOSEPH BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1134
Mailing Address - Country:US
Mailing Address - Phone:267-971-2333
Mailing Address - Fax:
Practice Address - Street 1:6015 ROSS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1134
Practice Address - Country:US
Practice Address - Phone:267-971-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA168482331L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes331L00000XSuppliersBlood Bank