Provider Demographics
NPI:1205302791
Name:BROWN, SAMUEL VINCENT
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:VINCENT
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 1:1334 FORT STEVENS DR NW APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5039
Mailing Address - Country:US
Mailing Address - Phone:202-230-6268
Mailing Address - Fax:
Practice Address - Street 1:1334 FORT STEVENS DR NW APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5039
Practice Address - Country:US
Practice Address - Phone:202-230-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant