Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 10935 | WV |
N | 207N00000X | Dermatologist | MD026005E | PA |
NPI | 1053436261 |
---|---|
Provider Name | Timothy A Brown |
First Address | Weirton, WV 26062-3777 |
Second Address | Weirton, WV 26062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016868800001 | (05) | PA |
0070312000 | (05) | WV |
070000589 | RAILROAD MEDICARE (01) | PA |
406012595 | RAILROAD MEDICARE (01) | WV |
C31428 | (02) |