MEDICARE: ERIC MICHAEL JABLONKA 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	208200000X	Plastic Surgery Physician	0101274084	VA

General Provider Information

NPI Number	:	1528367893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MICHAEL JABLONKA MD

Provider Business Mailing Address
First Line	:	2829 SHORE DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1498
Country	:	US
Telephone Number	:	757-734-1000
Fax Number	:	757-734-1001

Provider Business Practice Location Address
First Line	:	2829 SHORE DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1498
Country	:	US
Telephone Number	:	757-734-1000
Fax Number	:	757-734-1001

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	12/02/2022

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