Provider Demographics
NPI:1154470458
Name:BROWN, MARY GORDON BUCKINGHAM (NPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY GORDON
Middle Name:BUCKINGHAM
Last Name:BROWN
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-378-5010
Mailing Address - Fax:804-378-3264
Practice Address - Street 1:5875 BREMO ROAD
Practice Address - Street 2:SUITE 501
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-9899
Practice Address - Fax:804-282-2619
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167127207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA097991OtherANTHEM
VA097991OtherANTHEM