=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487635306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL T BROWN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2005
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6847 N CHESTNUT ST
-----------------------------------------------------
City | RAVENNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44266-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-577-5116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1317 ROUTE 73 STE 200
-----------------------------------------------------
City | MOUNT LAUREL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08054-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-439-6111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 34.008125
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34008125
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------