MEDICARE: ASSOCIATES IN PLASTIC SURGERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	0101030062	VA

General Provider Information

NPI Number	:	1083944557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN PLASTIC SURGERY, INC.

Provider Business Mailing Address
First Line	:	1037 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3037
Country	:	US
Telephone Number	:	757-491-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3037
Country	:	US
Telephone Number	:	757-491-3535
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JONATHAN JACOBS
Credential	:	DMD, MD, FACS
Telephone Number	:	757-491-3535

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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