Healthcare Provider Details

I. General information

NPI: 1982724175
Provider Name (Legal Business Name): MARION BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1031 RUNNYMEDE RD
DAYTON OH
45419-2919
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6270
  • Fax:
Mailing address:
  • Phone: 937-208-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberOH35.058198
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: