Provider Demographics
NPI:1245279033
Name:BROWN, BERYL S (MD)
Entity type:Individual
Prefix:
First Name:BERYL
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
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 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-481-4424
Mailing Address - Fax:757-481-3820
Practice Address - Street 1:1120 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2418
Practice Address - Country:US
Practice Address - Phone:757-481-4424
Practice Address - Fax:757-481-3820
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700252OtherUNITED HEALTHCARE
213059OtherCIGNA
253611OtherANTHEM
35068OtherOPTIMA HEALTH PLAN
5784157OtherGHI
VA007309872Medicaid
438550OtherMAMSI
5837203OtherAETNA
NC89064NPMedicaid
020046973OtherRAILROAD MEDICARE
020046973OtherRAILROAD MEDICARE
VA007309872Medicaid