Provider Demographics
NPI:1245253491
Name:BROWN, JOSEPH WALTER (DPM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WALTER
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N BANCROFT PKWY STE 12
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2668
Mailing Address - Country:US
Mailing Address - Phone:302-658-1129
Mailing Address - Fax:302-658-7646
Practice Address - Street 1:1501 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3615
Practice Address - Country:US
Practice Address - Phone:302-378-1022
Practice Address - Fax:302-378-9303
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005970213ES0103X
DEE1-0000262213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU91463Medicare UPIN
PA111566SZUMedicare PIN