Provider Demographics
NPI:1316098221
Name:BROWN, WILLIAM MARK (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1250
Mailing Address - Country:US
Mailing Address - Phone:570-207-2030
Mailing Address - Fax:570-207-2036
Practice Address - Street 1:1789 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1250
Practice Address - Country:US
Practice Address - Phone:570-207-2030
Practice Address - Fax:570-207-2036
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003890L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
247931OtherHEALTNET
PA780195OtherFIRST PRIORITY LIFE
PA000000086612Medicaid
PA780195OtherFEDERAL BLUE SHIELD
PAU58555OtherSTERLING
PA247931OtherHEALTHNET
PA780195OtherFIRST PRIORITY HEALTH
PA780195OtherBLUE SHIELD PERSONAL CARE
PA17105 6484OtherGEISINGER GOLD
PA2144133OtherUS HEALTHCARE
PA5521062OtherAETNA PPO
PA780195OtherFREEDOM BLUE
PA86612OtherUNISON
PAP00089348OtherRAILROAD MEDICARE
PA2Y7931OtherHAMER
PA2Y7931OtherHEAL
PA17105 6484OtherGEISINGER HEALTH
PA780195OtherPENNSYLVANIA BLUE SHIELD
PA780195OtherACCESS
PA2144133OtherAETNA
PA86612OtherMEDPLUS
PA780195OtherBLUE SHIELD PERSONAL CARE
PA780195OtherACCESS
PA000000086612Medicaid