Healthcare Provider Details

I. General information

NPI: 1669749818
Provider Name (Legal Business Name): BENJAMIN WATSON BROWN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
LANGLEY AFB VA
23665-2040
US

IV. Provider business mailing address

135 BOWEN ST
LANGLEY AFB VA
23665-1939
US

V. Phone/Fax

Practice location:
  • Phone: 803-230-4638
  • Fax:
Mailing address:
  • Phone: 803-230-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1669749818
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: