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General NPI Number Information
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NPI Number | 1871921817
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Entity Type | Individual
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Provider Name | STACEY BROWN DAFFRON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 3001 S HANOVER ST
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City | BALTIMORE
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State | MD
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Zip | 21225-1233
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Country | US
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Telephone | 410-350-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 100
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City | ANNAPOLIS
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State | MD
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Zip | 21401-8902
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Country | US
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Telephone | 443-481-5597
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Fax | 443-481-6790
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0005147
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License Number State | MD
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