=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912979089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK S BROWN M.D., F.A.C.O.G.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 04/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 E TOWN ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-224-0115
-----------------------------------------------------
Fax | 614-224-0776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 E TOWN ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-224-0115
-----------------------------------------------------
Fax | 614-224-0776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 0354965
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------