Provider Demographics
NPI:1225848674
Name:YOUR MEDICAL DOCTOR OF VIRGINIA, P.C.
Entity type:Organization
Organization Name:YOUR MEDICAL DOCTOR OF VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANTLEY
Authorized Official - Middle Name:TILMAN
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-643-1171
Mailing Address - Street 1:1539 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1539 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4128
Practice Address - Country:US
Practice Address - Phone:703-447-6897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty