Provider Demographics
NPI:1801424320
Name:BROWN, NOEL EDGAR
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:EDGAR
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NEBBIE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12024 BROWN MODER RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8840
Mailing Address - Country:US
Mailing Address - Phone:937-243-3703
Mailing Address - Fax:
Practice Address - Street 1:729 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1643
Practice Address - Country:US
Practice Address - Phone:937-642-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist