Provider Demographics
NPI:1902882152
Name:BROWN, MARCIA F (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:F
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-0607
Mailing Address - Country:US
Mailing Address - Phone:419-468-7613
Mailing Address - Fax:419-462-1260
Practice Address - Street 1:270 PORTLAND WAY S
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2362
Practice Address - Country:US
Practice Address - Phone:419-468-7613
Practice Address - Fax:419-462-1260
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH66557208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0969162Medicaid
G09196Medicare UPIN