MEDICARE: MARK S BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	R019040	NY

General Provider Information

NPI Number	:	1386767432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S BROWN

Provider Business Mailing Address
First Line	:	4600 MILLENNIUM DR
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1197
Country	:	US
Telephone Number	:	585-243-7250
Fax Number	:	585-243-7264

Provider Business Practice Location Address
First Line	:	4600 MILLENNIUM DR
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1197
Country	:	US
Telephone Number	:	585-243-7250
Fax Number	:	585-243-7264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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Directions to “ MARK S BROWN ” Practice Location

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