Healthcare Provider Details

I. General information

NPI: 1750930327
Provider Name (Legal Business Name): MR. PAUL RUSSELL BROWN II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E COLLEGE ST
BRIDGEWATER VA
22812-1511
US

IV. Provider business mailing address

20 MEMORIAL DR
NEW CASTLE DE
19720-1311
US

V. Phone/Fax

Practice location:
  • Phone: 540-828-8000
  • Fax:
Mailing address:
  • Phone: 302-893-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: