Healthcare Provider Details

I. General information

NPI: 1033234455
Provider Name (Legal Business Name): DEBRA MARIE BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LABORATORY CORPORATION OF AMERICA 312 6TH AVE
S. CHARLESTON WV
25303
US

IV. Provider business mailing address

31 LYNN LN
SCOTT DEPOT WV
25560-9531
US

V. Phone/Fax

Practice location:
  • Phone: 304-744-7017
  • Fax: 304-744-2096
Mailing address:
  • Phone: 187-753-0988
  • Fax: 304-744-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number22545
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: