Provider Demographics
NPI:1992785299
Name:BROWN, TOBY L (MD)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:L
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 1:5536 FREESTATE ROAD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115
Mailing Address - Country:US
Mailing Address - Phone:540-364-0213
Mailing Address - Fax:
Practice Address - Street 1:5536 FREESTATE ROAD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115
Practice Address - Country:US
Practice Address - Phone:540-364-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010311882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7230338Medicaid
VA6688-0001OtherCAREFIRST
VA7237588Medicaid
VA7237596Medicaid
VA7327618Medicaid
VA7248091Medicaid
VAD26950Medicare UPIN
VA7237596Medicaid