Healthcare Provider Details

I. General information

NPI: 1891908661
Provider Name (Legal Business Name): DR. RONALD STEPHEN BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 JENIFER ST NW STE 270
WASHINGTON DC
20015-2113
US

IV. Provider business mailing address

2206 N NELSON ST
ARLINGTON VA
22207-3841
US

V. Phone/Fax

Practice location:
  • Phone: 202-964-9400
  • Fax:
Mailing address:
  • Phone: 703-528-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2923
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4170
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5621
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: