Provider Demographics
NPI:1801140587
Name:BROWN, MAGGIE JANE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:MAGGIE
Middle Name:JANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 2016
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4726
Mailing Address - Fax:513-636-2808
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2016
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4726
Practice Address - Fax:513-636-2808
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003630207XX0005X
OH50.003630RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine