Healthcare Provider Details
I. General information
NPI: 1154368447
Provider Name (Legal Business Name): ELLEN RENEE BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/02/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
184 HOLIDAY HILLS DR
PARKERSBURG WV
26104-8006
US
IV. Provider business mailing address
602 17TH ST
VIENNA WV
26105-1104
US
V. Phone/Fax
- Phone: 304-420-2400
- Fax: 304-420-9014
- Phone: 304-482-5449
- Fax: 304-461-7082
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 35.099978 |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 21389 |
| License Number State | WV |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 042-0011212 |
| License Number State | VT |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0401X |
| Taxonomy | Addiction Medicine (Family Medicine) Physician |
| License Number | 35.099978 |
| License Number State | OH |
| # 5 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207QA0401X |
| Taxonomy | Addiction Medicine (Family Medicine) Physician |
| License Number | 21389 |
| License Number State | WV |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: