Provider Demographics
NPI:1740283191
Name:BROWN, CHARLES CALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CALVIN
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 1:411 INLET DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3231
Mailing Address - Country:US
Mailing Address - Phone:252-338-3858
Mailing Address - Fax:
Practice Address - Street 1:1403 GREENBRIER PKWY
Practice Address - Street 2:STE 401
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0407
Practice Address - Country:US
Practice Address - Phone:757-965-4018
Practice Address - Fax:757-965-4268
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234662208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C82987Medicare UPIN
VAC09419Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE