Healthcare Provider Details

I. General information

NPI: 1417081803
Provider Name (Legal Business Name): LOUIS ALFRED BROWN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 RISING SUN AVE
PHILADELPHIA PA
19111-5630
US

IV. Provider business mailing address

6326 RISING SUN AVE
PHILADELPHIA PA
19111-5630
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-9794
  • Fax: 215-745-3775
Mailing address:
  • Phone: 215-745-9794
  • Fax: 215-745-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD 032402-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: