Provider Demographics
NPI:1760621312
Name:BROWN, RICHARD COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:COLEMAN
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8999
Mailing Address - Fax:757-446-7922
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8999
Practice Address - Fax:757-446-7922
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010163632083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1004306OtherSENTARA/OPTIMA
VA368047OtherANTHEM BC/BS
VA-032OtherTRICARE/CHAMPUS
VA2197287OtherUNITED HEALTH CARE/MAMSI
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
NC5911262Medicaid
VAPAROtherVA PREMIER HEALTH
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH
NC11262OtherBC/BS OF NC
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VA1760621312Medicaid
VAPAROtherCORVEL/CORCARE