Provider Demographics
NPI:1639212236
Name:STANLEY-JOLLY, EBONI L (MD)
Entity Type:Individual
Prefix:DR
First Name:EBONI
Middle Name:L
Last Name:STANLEY-JOLLY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1715 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3609
Mailing Address - Country:US
Mailing Address - Phone:703-248-0006
Mailing Address - Fax:703-248-0007
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:SUITE 402
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-248-0006
Practice Address - Fax:703-248-0007
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2009-12-03
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Provider Licenses
StateLicense IDTaxonomies
MDP17826208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022001A94Medicare PIN