Healthcare Provider Details

I. General information

NPI: 1669456570
Provider Name (Legal Business Name): MARCUS WENDELL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W MARSHALL ST
RICHMOND VA
23220-3835
US

IV. Provider business mailing address

1109 W MARSHALL ST
RICHMOND VA
23220-3835
US

V. Phone/Fax

Practice location:
  • Phone: 804-257-7337
  • Fax: 804-359-6898
Mailing address:
  • Phone: 804-257-7337
  • Fax: 804-359-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101041905
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: