=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285963801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVROM STEWART BROWN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2009
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8304 CEDAR RD
-----------------------------------------------------
City | ELKINS PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19027-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-913-7892
-----------------------------------------------------
Fax | 215-782-8983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8304 CEDAR RD
-----------------------------------------------------
City | ELKINS PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19027-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-913-7892
-----------------------------------------------------
Fax | 215-782-8983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS003255L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | OS003255L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------