Basic Information
| Provider Information | |||||||||
| NPI: | 1770595688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4536 BONNEY RD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234623869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574909388 | ||||||||
| FaxNumber: | 7574909401 | ||||||||
| Practice Location | |||||||||
| Address1: | 736 BATTLEFIELD BLVD N | ||||||||
| Address2: | CHESAPEAKE GENERAL HOSPITAL | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574909388 | ||||||||
| FaxNumber: | 7574909401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 0101224731 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 01064276A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 268745 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2016011278 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD2015-0400 | NM | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110118587A | 05 | MA | MEDICAID | 930091447 | 01 | MEDICARE RAILROAD | OTHER | 063UA | 01 | BLUE CROSS BLUE SHIELD NC | OTHER | 5841275 | 05 | VA | MEDICAID | 082480 | 01 | BLUE CROSS BLUE SHIELD VA | OTHER | 251490 | 01 | MAMSI | OTHER | 3900570 | 01 | OPTIMUM CHOICE | OTHER | 89063UA | 05 | NC | MEDICAID | 000000529965 | 01 | IN | ANTHEM | OTHER | 27946 | 01 | OPTIMA | OTHER | 200875270 | 05 | IN | MEDICAID |