MEDICARE: DR. BETH RACHELLE JAKLIC M.D.

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	208C00000X	Colon & Rectal Surgery Physician	0101046986	VA

General Provider Information

NPI Number	:	1396725636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH RACHELLE JAKLIC M.D.

Provider Business Mailing Address
First Line	:	2808 OCEAN MIST CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1230
Country	:	US
Telephone Number	:	757-650-3047
Fax Number	:	757-419-4898

Provider Business Practice Location Address
First Line	:	1301 FIRST COLONIAL RD STE 201
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2263
Country	:	US
Telephone Number	:	757-419-4919
Fax Number	:	757-419-4898

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	02/19/2021

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