Provider Demographics
NPI:1053436261
Name:BROWN, TIMOTHY A (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 PENNSYLVANIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3777
Mailing Address - Country:US
Mailing Address - Phone:304-723-3090
Mailing Address - Fax:304-723-2576
Practice Address - Street 1:2619 PENNSYLVANIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-3090
Practice Address - Fax:304-723-2576
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026005E207N00000X
WV10935207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070000589OtherRAILROAD MEDICARE
PA0016868800001Medicaid
WV0070312000Medicaid
WV406012595OtherRAILROAD MEDICARE
C31428Medicare UPIN