Healthcare Provider Details

I. General information

NPI: 1164473179
Provider Name (Legal Business Name): JENNIFER B. BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13332 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-4210
US

IV. Provider business mailing address

13332 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-4210
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-5598
  • Fax: 804-378-1954
Mailing address:
  • Phone: 804-794-5598
  • Fax: 804-378-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101042468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: