Healthcare Provider Details

I. General information

NPI: 1538663273
Provider Name (Legal Business Name): CRAIG CAMERON BRAWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 GLADE FERN TER SE
LEESBURG VA
20175-5422
US

IV. Provider business mailing address

19490 SANDRIDGE WAY STE 70
LEESBURG VA
20176-3472
US

V. Phone/Fax

Practice location:
  • Phone: 571-252-9237
  • Fax: 571-200-9703
Mailing address:
  • Phone: 571-252-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125.072627
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number1010280100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: