Healthcare Provider Details

I. General information

NPI: 1255674719
Provider Name (Legal Business Name): A'SHA MABLE BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRANITE DR STE 7
MEDIA PA
19063-5134
US

IV. Provider business mailing address

100 GRANITE DR STE 7
MEDIA PA
19063-5134
US

V. Phone/Fax

Practice location:
  • Phone: 610-606-1671
  • Fax: 215-843-4888
Mailing address:
  • Phone: 610-606-1671
  • Fax: 215-893-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License NumberMD479184
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License NumberD0090772
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License NumberC1-0024054
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101264411
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberC1-0024054
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD0090772
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD479184
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: