Healthcare Provider Details

I. General information

NPI: 1386470292
Provider Name (Legal Business Name): MR. ANTHONY ROLANDO BROWN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 BARLOW DR
PORTSMOUTH VA
23707-1368
US

IV. Provider business mailing address

533 BARLOW DR
PORTSMOUTH VA
23707-1368
US

V. Phone/Fax

Practice location:
  • Phone: 757-531-5131
  • Fax:
Mailing address:
  • Phone: 757-531-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberT60618120
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: