Provider Demographics
NPI:1275732067
Name:MIHALIK, JENNIFER ERIN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:MIHALIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HEALTH CAMPUS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8679
Mailing Address - Country:US
Mailing Address - Phone:540-689-5800
Mailing Address - Fax:757-579-8580
Practice Address - Street 1:2006 HEALTH CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5800
Practice Address - Fax:757-579-8580
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37870208600000X
VA0101267208208600000X
AL311842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-19876OtherBLUE CROSS AND BLUE SHIELD
AL131464Medicaid
AL131464Medicaid