Provider Demographics
NPI:1518986132
Name:BROWN, JEFFREY BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BERNARD
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:301-497-5489
Practice Address - Street 1:3357B CORRIDOR MARKETPLACE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2381
Practice Address - Country:US
Practice Address - Phone:301-497-1820
Practice Address - Fax:301-497-5489
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157485207R00000X
MDD63830208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526040658001OtherCHAMPUS
MD410956200Medicaid
88843402OtherCAREFIRST MD
V8260035OtherCAREFIRST DC
MD526040658001OtherCHAMPUS
88843402OtherCAREFIRST MD
I10125Medicare UPIN
MDP00346695Medicare PIN