Healthcare Provider Details

I. General information

NPI: 1790746873
Provider Name (Legal Business Name): DOUGLAS BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KINGSLEY LN SUITE 305
NORFOLK VA
23505-4617
US

IV. Provider business mailing address

408 54TH ST
VIRGINIA BEACH VA
23451-2323
US

V. Phone/Fax

Practice location:
  • Phone: 804-262-6900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberJ3440
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101052191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: