Healthcare Provider Details

I. General information

NPI: 1902882152
Provider Name (Legal Business Name): MARCIA F BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PORTLAND WAY S
GALION OH
44833-2362
US

IV. Provider business mailing address

PO BOX 607
GALION OH
44833-0607
US

V. Phone/Fax

Practice location:
  • Phone: 419-468-7613
  • Fax: 419-462-1260
Mailing address:
  • Phone: 419-468-7613
  • Fax: 419-462-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66557
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: