Provider Demographics
NPI:1154368447
Name:BROWN, ELLEN RENEE (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:RENEE
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:602 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1104
Mailing Address - Country:US
Mailing Address - Phone:304-482-5449
Mailing Address - Fax:304-461-7082
Practice Address - Street 1:184 HOLIDAY HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8006
Practice Address - Country:US
Practice Address - Phone:304-420-2400
Practice Address - Fax:304-420-9014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099978207Q00000X, 207QA0401X
WV21389207Q00000X, 207QA0401X
VT042-0011212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023925Medicaid
OHP01138126OtherRAILROAD MEDICARE
OH0075906Medicaid
VT1012998Medicaid
I24927Medicare UPIN
VT1012998Medicaid
WV3810023925Medicaid