Provider Demographics
NPI:1639840770
Name:BROWN, WAYNE T JR
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:T
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 HILLSIDE RD SE UNIT A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4963
Mailing Address - Country:US
Mailing Address - Phone:571-264-7422
Mailing Address - Fax:
Practice Address - Street 1:18622 TRIANGLE ST
Practice Address - Street 2:
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-1939
Practice Address - Country:US
Practice Address - Phone:571-264-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver