Provider Demographics
NPI:1710981246
Name:ADLEBERG, JON MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MICHAEL
Last Name:ADLEBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:516 INNOVATION DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3866
Mailing Address - Country:US
Mailing Address - Phone:757-436-0011
Mailing Address - Fax:757-436-0075
Practice Address - Street 1:516 INNOVATION DR
Practice Address - Street 2:STE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3866
Practice Address - Country:US
Practice Address - Phone:757-436-0011
Practice Address - Fax:757-436-0075
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2017-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9800004174400000X, 207W00000X, 207WX0107X
VA0101056722174400000X, 207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006309895Medicaid
VA006309895Medicaid
VAG06508Medicare UPIN