Provider Demographics
NPI:1437105467
Name:MUNALULA, JABULANI (MD)
Entity Type:Individual
Prefix:
First Name:JABULANI
Middle Name:
Last Name:MUNALULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-397-3400
Mailing Address - Fax:757-399-0371
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-396-6333
Practice Address - Fax:757-396-6367
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241103208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
10022031OtherOPTIMA
755184OtherAETNA
P00638801OtherMEDICARE RAILROAD
VA301730OtherANTHEM BCBS
VA1437105467Medicaid
NC5908181Medicaid
0162448OtherGHI
NC5908181Medicaid