Provider Demographics
NPI:1134397326
Name:HUGO, JACOBUS BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:JACOBUS
Middle Name:BENJAMIN
Last Name:HUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:BEN
Other - Last Name:HUGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:328 LOUISA AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4668
Mailing Address - Country:US
Mailing Address - Phone:757-496-4801
Mailing Address - Fax:757-496-4848
Practice Address - Street 1:328 LOUISA AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4668
Practice Address - Country:US
Practice Address - Phone:757-496-4801
Practice Address - Fax:757-496-4848
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0005250455174400000X
VA0101048532208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist