Healthcare Provider Details

I. General information

NPI: 1588607089
Provider Name (Legal Business Name): SUSAN MELINDA BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MELINDA SAMUEL MD

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE STE 202A
NORFOLK VA
23510-1065
US

IV. Provider business mailing address

301 RIVERVIEW AVE STE 202A
NORFOLK VA
23510-1065
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-5325
  • Fax: 757-510-9041
Mailing address:
  • Phone: 757-622-5325
  • Fax: 757-510-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2019-01842
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101057870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: