MEDICARE: DR. CARLTON Q BROWN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	0101039828	VA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	0101039828	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G01730M01	OTHER		GROUP/INDIVIDUAL NUMBER

General Provider Information

NPI Number	:	1992792139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON Q BROWN MD

Provider Business Mailing Address
First Line	:	507 SPRINGVALE RD
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-3424
Country	:	US
Telephone Number	:	703-759-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 SPRINGVALE RD
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-3424
Country	:	US
Telephone Number	:	703-759-3630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/12/2008

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