Healthcare Provider Details

I. General information

NPI: 1003203126
Provider Name (Legal Business Name): BETHANY BROWN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PARK CENTER CT STE 150
OWINGS MILLS MD
21117
US

IV. Provider business mailing address

9 PARK CENTER CT STE 150
OWINGS MILLS MD
21117-5623
US

V. Phone/Fax

Practice location:
  • Phone: 410-902-7710
  • Fax: 410-902-4410
Mailing address:
  • Phone: 410-902-7710
  • Fax: 410-902-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0085213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: