Provider Demographics
NPI:1386058147
Name:BROWN, PHILLIP WILLIAM (DPM)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:WILLIAM
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 1:923 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2274
Mailing Address - Country:US
Mailing Address - Phone:412-508-0917
Mailing Address - Fax:
Practice Address - Street 1:5841 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-3333
Practice Address - Country:US
Practice Address - Phone:412-831-1515
Practice Address - Fax:412-831-2115
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC006802213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program