Healthcare Provider Details

I. General information

NPI: 1134397326
Provider Name (Legal Business Name): JACOBUS BENJAMIN HUGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: J. BEN HUGO M.D.

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 LOUISA AVENUE SUITE 110
VIRGINIA BEACH VA
23454-4668
US

IV. Provider business mailing address

328 LOUISA AVENUE SUITE 110
VIRGINIA BEACH VA
23454-4668
US

V. Phone/Fax

Practice location:
  • Phone: 757-496-4801
  • Fax: 757-496-4848
Mailing address:
  • Phone: 757-496-4801
  • Fax: 757-496-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0005250455
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101048532
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: