Provider Demographics
NPI:1174939771
Name:TELE-PHYSICIANS, P.C.
Entity type:Organization
Organization Name:TELE-PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRANTLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-224-1069
Mailing Address - Street 1:1768 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1768 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5324
Practice Address - Country:US
Practice Address - Phone:703-225-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty