MEDICARE: JABULANI MUNALULA MD

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	208600000X	Surgery Physician	0101241103	VA
2	2086X0206X	Surgical Oncology Physician	0101241103	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00638801	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10022031	OTHER		OPTIMA
2	755184	OTHER		AETNA
4	301730	OTHER	VA	ANTHEM BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0162448	OTHER		GHI

General Provider Information

NPI Number	:	1437105467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JABULANI MUNALULA MD

Provider Business Mailing Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 102
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-397-3400
Fax Number	:	757-399-0371

Provider Business Practice Location Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 300
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-396-6333
Fax Number	:	757-396-6367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	12/16/2008

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Directions to “ JABULANI MUNALULA MD” Practice Location

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