Healthcare Provider Details

I. General information

NPI: 1336105808
Provider Name (Legal Business Name): CHARLES A BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 CLEVELAND RD
WOOSTER OH
44691-2203
US

IV. Provider business mailing address

1740 CLEVELAND RD
WOOSTER OH
44691-2204
US

V. Phone/Fax

Practice location:
  • Phone: 330-287-4930
  • Fax: 330-264-2085
Mailing address:
  • Phone: 330-287-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35032516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: