Provider Demographics
NPI:1245294578
Name:BROWN, JAMES EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
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 1:2010 DOCTOR OATES DR
Mailing Address - Street 2:STE 106
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-264-8603
Mailing Address - Fax:304-264-1577
Practice Address - Street 1:2010 DOCTOR OATES DR
Practice Address - Street 2:STE 106
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-264-8603
Practice Address - Fax:304-264-1577
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17896207V00000X
TN14657207V00000X
KY22260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092928000Medicaid
BR0768181Medicare ID - Type Unspecified
A96974Medicare UPIN