Healthcare Provider Details

I. General information

NPI: 1174904577
Provider Name (Legal Business Name): JOSHUA M BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010
US

IV. Provider business mailing address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS019628
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: