Healthcare Provider Details

I. General information

NPI: 1598741456
Provider Name (Legal Business Name): SUSAN GOLLOBIN BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 SKIPWITH RD
RICHMOND VA
23229-5205
US

IV. Provider business mailing address

PO BOX 452409
SUNRISE FL
33345-2409
US

V. Phone/Fax

Practice location:
  • Phone: 804-289-4528
  • Fax: 804-287-4388
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101044969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: