Provider Demographics
NPI:1104326040
Name:BROWN, ANTHON CHARLES
Entity type:Individual
Prefix:MR
First Name:ANTHON
Middle Name:CHARLES
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9764
Mailing Address - Country:US
Mailing Address - Phone:304-710-5358
Mailing Address - Fax:304-948-6364
Practice Address - Street 1:5505 US ROUTE 60 STE 190
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2031
Practice Address - Country:US
Practice Address - Phone:304-955-5945
Practice Address - Fax:304-948-6364
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2021-07-22
Deactivation Date:2018-10-19
Deactivation Code:
Reactivation Date:2021-07-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist