Provider Demographics
NPI:1952380586
Name:BROWN, ABDULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDULLAH
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3740
Mailing Address - Country:US
Mailing Address - Phone:571-243-4555
Mailing Address - Fax:
Practice Address - Street 1:600 GRACE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3740
Practice Address - Country:US
Practice Address - Phone:571-243-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234403207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010071143Medicaid
173386OtherANTHEM
173386OtherANTHEM
014668R25Medicare ID - Type Unspecified
VA010071143Medicaid