Provider Demographics
NPI:1669456570
Name:BROWN, MARCUS WENDELL
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:WENDELL
Last Name:BROWN
Suffix:
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 1:1109 W MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3835
Mailing Address - Country:US
Mailing Address - Phone:804-257-7337
Mailing Address - Fax:804-359-6898
Practice Address - Street 1:1109 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3835
Practice Address - Country:US
Practice Address - Phone:804-257-7337
Practice Address - Fax:804-359-6898
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010419052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA920000066Medicare ID - Type Unspecified