Provider Demographics
NPI:1174535009
Name:BROWN, LEON (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
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 1:101 COWARDIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2078
Mailing Address - Country:US
Mailing Address - Phone:804-232-7876
Mailing Address - Fax:804-232-1708
Practice Address - Street 1:101 COWARDIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2078
Practice Address - Country:US
Practice Address - Phone:804-232-7876
Practice Address - Fax:804-232-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101028525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174535009OtherNPI
VA005672601Medicaid
558686OtherAETNA
005692OtherHMO ID
20106OtherVIRGINIA PREMIER
M3656OtherKEY ADV ID
005692OtherANTHEM
091191OtherCIGNA
826237OtherMDIPA ID
VA00X977L01Medicare PIN