Provider Demographics
NPI:1245572890
Name:BROWN, MATTHEW JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAY
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1051 HARDING MEMORIAL PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6347
Mailing Address - Country:US
Mailing Address - Phone:740-383-5115
Mailing Address - Fax:740-387-3668
Practice Address - Street 1:1051 HARDING MEMORIAL PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6347
Practice Address - Country:US
Practice Address - Phone:740-383-5115
Practice Address - Fax:740-387-3668
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003755213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160508Medicaid
OHH463040Medicare PIN