Provider Demographics
NPI:1992923825
Name:ULEP, BENJAMIN TABIOLO (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TABIOLO
Last Name:ULEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12705 KARLYN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2553
Mailing Address - Country:US
Mailing Address - Phone:804-530-0906
Mailing Address - Fax:804-834-2600
Practice Address - Street 1:SUSSEX II STATE PRISON
Practice Address - Street 2:24427 MUSSELWHITE DR
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23891-0001
Practice Address - Country:US
Practice Address - Phone:804-834-2678
Practice Address - Fax:804-834-2600
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice