Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101241103 | VA |
N | 208600000X | Surgeon | 0101241103 | VA |
Y | 2086X0206X | Surgical Oncologist | 0101241103 | VA |
NPI | 1437105467 |
---|---|
Provider Name | Jabulani Munalula |
First Address | Portsmouth, VA 23704-2816 |
Second Address | Portsmouth, VA 23704-2816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 16/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0162448 | GHI (01) | |
10022031 | OPTIMA (01) | |
1437105467 | (05) | VA |
301730 | ANTHEM BCBS (01) | VA |
5908181 | (05) | NC |
755184 | AETNA (01) | |
P00638801 | MEDICARE RAILROAD (01) |