Healthcare Provider Details

I. General information

NPI: 1134499981
Provider Name (Legal Business Name): BLAKE L. BROWN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HEALTH CAMPUS DR STE 300
ROCKINGHAM VA
22801-8679
US

IV. Provider business mailing address

2006 HEALTH CAMPUS DR STE 300
ROCKINGHAM VA
22801-8679
US

V. Phone/Fax

Practice location:
  • Phone: 540-689-7400
  • Fax: 757-963-9617
Mailing address:
  • Phone: 540-689-7400
  • Fax: 757-963-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: