Provider Demographics
NPI:1912979089
Name:BROWN, MARK S (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4602
Mailing Address - Country:US
Mailing Address - Phone:614-224-0115
Mailing Address - Fax:614-224-0776
Practice Address - Street 1:270 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4602
Practice Address - Country:US
Practice Address - Phone:614-224-0115
Practice Address - Fax:614-224-0776
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0354965207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0642992OtherAETNA
OH2154083Medicaid
OH0678842Medicaid
OH000000017343OtherANTHEM
OH0678842Medicaid