Provider Demographics
NPI:1144410432
Name:BROWN, SR., JAMES MARTIN (CPED)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARTIN
Last Name:BROWN, SR.
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14437 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2805
Mailing Address - Country:US
Mailing Address - Phone:703-491-4222
Mailing Address - Fax:703-491-1040
Practice Address - Street 1:14437 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2805
Practice Address - Country:US
Practice Address - Phone:703-491-4222
Practice Address - Fax:703-491-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1163840001Medicare PIN