Basic Information
| Provider Information | |||||||||
| NPI: | 1710120407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | LEMARRA | ||||||||
| MiddleName: | RENA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPM, DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094072337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 408 CHRIS GAUPP DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082054492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097485015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MB10111600 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 25MB10111600 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.