Healthcare Provider Details
I. General information
NPI: 1316098221
Provider Name (Legal Business Name): WILLIAM MARK BROWN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 01/16/2007
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1789 N KEYSER AVE
SCRANTON PA
18508-1250
US
IV. Provider business mailing address
1789 N KEYSER AVE
SCRANTON PA
18508-1250
US
V. Phone/Fax
- Phone: 570-207-2030
- Fax: 570-207-2036
- Phone: 570-207-2030
- Fax: 570-207-2036
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213ES0131X |
| Taxonomy | Foot Surgery Podiatrist |
| License Number | SC003890L |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 247931 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTNET |
| # 2 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | FIRST PRIORITY LIFE |
| # 3 | |
| Identifier | 000000086612 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 4 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | FEDERAL BLUE SHIELD |
| # 5 | |
| Identifier | U58555 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | STERLING |
| # 6 | |
| Identifier | 247931 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HEALTHNET |
| # 7 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | FIRST PRIORITY HEALTH |
| # 8 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | BLUE SHIELD PERSONAL CARE |
| # 9 | |
| Identifier | 17105 6484 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GEISINGER GOLD |
| # 10 | |
| Identifier | 2144133 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | US HEALTHCARE |
| # 11 | |
| Identifier | 5521062 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA PPO |
| # 12 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | FREEDOM BLUE |
| # 13 | |
| Identifier | 86612 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | UNISON |
| # 14 | |
| Identifier | P00089348 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | RAILROAD MEDICARE |
| # 15 | |
| Identifier | 2Y7931 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HAMER |
| # 16 | |
| Identifier | 2Y7931 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HEAL |
| # 17 | |
| Identifier | 17105 6484 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GEISINGER HEALTH |
| # 18 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | PENNSYLVANIA BLUE SHIELD |
| # 19 | |
| Identifier | 780195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | ACCESS |
| # 20 | |
| Identifier | 2144133 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA |
| # 21 | |
| Identifier | 86612 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | MEDPLUS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
