Provider Demographics
NPI:1770585721
Name:BROWN, MARK G (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LIBERTY AVE STE 2000
Mailing Address - Street 2:THREE GATEWAY CENTER, 20TH FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1029
Mailing Address - Country:US
Mailing Address - Phone:412-223-2272
Mailing Address - Fax:412-281-6320
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-447-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072455L2085R0202X
OH35.1361712085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018263370026Medicaid
PAP00767228OtherRAILROAD MEDICARE
PA001826337-0024Medicaid
PA0018263370001Medicaid
PA131507OtherHIGHMARK BCBS
PA042503WUHMedicare PIN
PA0018263370026Medicaid
PA001826337-0024Medicaid
PAP00767228OtherRAILROAD MEDICARE