Healthcare Provider Details

I. General information

NPI: 1083944557
Provider Name (Legal Business Name): ASSOCIATES IN PLASTIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
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:
Mailing address:
  • Phone: 757-491-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101030062
License Number StateVA

VIII. Authorized Official

Name: DR. JONATHAN JACOBS
Title or Position: PARTNER
Credential: DMD, MD, FACS
Phone: 757-491-3535