Basic Information
| Provider Information | |||||||||
| NPI: | 1932168192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | MARYALLYSON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1109 | ||||||||
| Address2: | |||||||||
| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194561109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824778 | ||||||||
| FaxNumber: | 6106663310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 MEDICAL DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849250500 | ||||||||
| FaxNumber: | 6104320545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD-068485-L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 507297 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0017521440009 | 05 | PA | MEDICAID | 0264802000 | 01 | PA | PERSONAL CHOICE | OTHER | 3942507 | 01 | PA | AETNA | OTHER | 0264802000 | 01 | PA | KEYSTONE HEALTH PLAN EAST | OTHER | 30022539 | 01 | PA | KEYSTONE MERCY | OTHER | G93641 | 01 | PA | UPIN | OTHER |