Healthcare Provider Details

I. General information

NPI: 1689715005
Provider Name (Legal Business Name): PAULA JEAN BROWN PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MONUMENT ROAD BELMONT CENTER
PHILADELPHIA PA
19131
US

IV. Provider business mailing address

4200 MONUMENT ROAD BELMONT CENTER
PHILADELPHIA PA
19131
US

V. Phone/Fax

Practice location:
  • Phone: 215-581-9142
  • Fax: 215-581-3827
Mailing address:
  • Phone: 215-581-9142
  • Fax: 215-581-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC003672
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: