Healthcare Provider Details

I. General information

NPI: 1053426502
Provider Name (Legal Business Name): ASSOCIATES IN PLASTIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3037
US

IV. Provider business mailing address

1037 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3037
US

V. Phone/Fax

Practice location:
  • Phone: 757-491-3535
  • Fax: 757-422-4750
Mailing address:
  • Phone: 757-491-3535
  • Fax: 757-422-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN S JACOBS
Title or Position: PRESIDENT
Credential: D.M.D.,M.D.,F.A.C.S.
Phone: 757-491-3535