Provider Demographics
NPI:1063412179
Name:BROWNE, ROGER W (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:BROWNE
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 1:2100 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1628
Mailing Address - Country:US
Mailing Address - Phone:434-572-6946
Mailing Address - Fax:434-572-6675
Practice Address - Street 1:2100 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1628
Practice Address - Country:US
Practice Address - Phone:434-572-6946
Practice Address - Fax:434-572-6675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
014296OtherBCBS
C00552OtherHAPPS MILL MED.ASSOC.LTD
B04972Medicare UPIN