Provider Demographics
NPI:1932168192
Name:BROWN, MARYALLYSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYALLYSON
Middle Name:
Last Name: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:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-1109
Mailing Address - Country:US
Mailing Address - Phone:610-482-4778
Mailing Address - Fax:610-666-3310
Practice Address - Street 1:1610 MEDICAL DR STE 105
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3279
Practice Address - Country:US
Practice Address - Phone:484-925-0500
Practice Address - Fax:610-432-0545
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-068485-L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA507297OtherHIGHMARK BLUE SHIELD
PA0017521440009Medicaid
PA0264802000OtherPERSONAL CHOICE
PA3942507OtherAETNA
PA0264802000OtherKEYSTONE HEALTH PLAN EAST
PA30022539OtherKEYSTONE MERCY
PAG93641OtherUPIN
PA0017521440009Medicaid