Provider Demographics
NPI:1174550503
Name:BROWN, LANCE H (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:H
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LANCE
Other - Middle Name:H
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10 WEST 15TH STREET, GROUND FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-924-7546
Mailing Address - Fax:212-924-7557
Practice Address - Street 1:10 WEST 15TH STREET, GROUND FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-924-7546
Practice Address - Fax:212-924-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2107991207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG72947Medicare UPIN
NY07U78YTYW1Medicare PIN