Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 35-056288 | OH |
Y | 208200000X | Surgeon | 35-056288 | OH |
Y | 208600000X | Surgeon | 35-056288 | OH |
NPI | 1497808281 |
---|---|
Provider Name | Dr. Mark Mandell-Brown |
First Address | Cincinnati, OH 45242-3215 |
Second Address | Cincinnati, OH 45242-3215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 17/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A17185 | (02) | |
P00134493 | RR MEDICARE (01) | OH |