Provider Demographics
NPI:1497755656
Name:BROWN, BARRETT BOLTON (MD)
Entity Type:Individual
Prefix:
First Name:BARRETT
Middle Name:BOLTON
Last Name:BROWN
Suffix:
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:PO BOX 221322
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-1322
Mailing Address - Country:US
Mailing Address - Phone:703-776-2368
Mailing Address - Fax:
Practice Address - Street 1:3289 WOODBURN ROAD
Practice Address - Street 2:SUITE #220
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-698-1080
Practice Address - Fax:703-698-1082
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047808207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006644732Medicaid
VA220018829OtherRAILROAD MEDICARE
VAF40845Medicare UPIN
VA220018829OtherRAILROAD MEDICARE
156717F82Medicare ID - Type Unspecified