Basic Information
| Provider Information | |||||||||
| NPI: | 1780614214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 4TH ST | ||||||||
| Address2: | |||||||||
| City: | EAST BERLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173169638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178464644 | ||||||||
| FaxNumber: | 7172597262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD026151E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 80707 | 01 | PA | UNISON-WMG | OTHER | 01059601 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 233283 | 01 | PA | MAMSI-WMG | OTHER | 30031 | 01 | PA | JOHNS HOPKINS | OTHER | 49366 | 01 | PA | GEISINGER | OTHER | P002798 | 01 | PA | GATEWAY-WMG | OTHER | 1142345 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 162704 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 4555802 | 01 | PA | AETNA | OTHER | 542989 | 01 | MD | CAREFIRST MD BCBS | OTHER | 000913572 | 05 | PA | MEDICAID |