Provider Demographics
NPI:1912992165
Name:DAVIS-BROWN, SUSAN FREDERICA (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FREDERICA
Last Name:DAVIS-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-8227
Mailing Address - Country:US
Mailing Address - Phone:937-833-1621
Mailing Address - Fax:937-833-5359
Practice Address - Street 1:950 SALEM ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-8227
Practice Address - Country:US
Practice Address - Phone:937-833-1621
Practice Address - Fax:937-833-5359
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072835207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2019194Medicaid
OH2019194Medicaid
G25283Medicare UPIN