Provider Demographics
NPI:1811910565
Name:BROWN, CORY A (DO)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7337 CARITAS CIR NW STE 100
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9127
Mailing Address - Country:US
Mailing Address - Phone:330-830-6202
Mailing Address - Fax:234-203-3597
Practice Address - Street 1:7337 CARITAS CIR NW STE 100
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9127
Practice Address - Country:US
Practice Address - Phone:330-830-6202
Practice Address - Fax:234-203-3597
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34007445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2841723Medicaid
OHBR4086102Medicare PIN
OH2841723Medicaid