Provider Demographics
NPI:1033179353
Name:BROWN, ROBERT STANLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STANLEY
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FAULCONER DRIVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-293-4200
Mailing Address - Fax:
Practice Address - Street 1:505 FAULCONER DRIVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903
Practice Address - Country:US
Practice Address - Phone:434-293-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035362207R00000X, 2084P0800X
NC35850207R00000X, 2084P0800X
WV20942207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
078466OtherBCBS ANTHEM
260001069Medicare ID - Type Unspecified
078466OtherBCBS ANTHEM