Provider Demographics
NPI:1144320862
Name:BROWN, ALEXANDER JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JAMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HOLLY DR
Mailing Address - Street 2:APT. B16
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2053
Mailing Address - Country:US
Mailing Address - Phone:518-852-6964
Mailing Address - Fax:
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2507
Practice Address - Country:US
Practice Address - Phone:315-349-5513
Practice Address - Fax:315-349-5726
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical