MEDICARE: NATHANIAL BROWN P.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	APP-000078993	OH

General Provider Information

NPI Number	:	1972040277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIAL BROWN P.A

Provider Business Mailing Address
First Line	:	30407 WOOD OAK CIR
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-3741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1015
Country	:	US
Telephone Number	:	440-759-3613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	05/20/2022

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