Healthcare Provider Details

I. General information

NPI: 1447522115
Provider Name (Legal Business Name): BROWN FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 E BETHLEHEM BLVD
WHEELING WV
26003-4961
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-905-9634
  • Fax:
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2349
License Number StateWV

VIII. Authorized Official

Name: YEKATERINA BROWN
Title or Position: OWNER
Credential: DO
Phone: 304-905-9634