Provider Demographics
NPI:1871799361
Name:BRAWLEY, JESSICA R (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:BRAWLEY
Suffix:
Gender:F
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:PO BOX 11314
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:908 EDEN WAY N STE 1
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3336
Practice Address - Country:US
Practice Address - Phone:757-252-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256098207Q00000X, 207Q00000X
MO2009002203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine