Basic Information
Provider Information
NPI: 1194719104
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWDER
FirstName: DAVID
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7200
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278040200
CountryCode: US
TelephoneNumber: 2529370351
FaxNumber: 2524510056
Practice Location
Address1: 91 ENTERPRISE DR
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278049590
CountryCode: US
TelephoneNumber: 2524513200
FaxNumber: 2529373107
Other Information
ProviderEnumerationDate: 09/06/2005
LastUpdateDate: 02/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X9600876NCY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
626280301NCAETNAOTHER
144640001NCUNITED HEALTHCAREOTHER
1860101NCBCBSNCOTHER
889725401NCCIGNAOTHER
11013273701NCRAILROAD MEDICAREOTHER
891860105NC MEDICAID
6950301NCMEDCOSTOTHER


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