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1154368447

NPI Code Detail

MEDICARE: ELLEN RENEE BROWN MD

MEDICARE: ELLEN RENEE BROWN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35.099978	OH
2	207Q00000X	Family Medicine Physician	21389	WV
3	207Q00000X	Family Medicine Physician	042-0011212	VT
4	207QA0401X	Addiction Medicine (Family Medicine) Physician	35.099978	OH
5	207QA0401X	Addiction Medicine (Family Medicine) Physician	21389	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01138126	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154368447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN RENEE BROWN MD

Provider Business Mailing Address
First Line	:	602 17TH ST
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-1104
Country	:	US
Telephone Number	:	304-482-5449
Fax Number	:	304-461-7082

Provider Business Practice Location Address
First Line	:	184 HOLIDAY HILLS DR
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26104-8006
Country	:	US
Telephone Number	:	304-420-2400
Fax Number	:	304-420-9014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	09/30/2024

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Directions to “ ELLEN RENEE BROWN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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