| Doctor Name: | DR. BENJAMIN TABIOLO ULEP |
| NPI Number: | 1992923825 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0101840437 |
| Business Practice Address: | Sussex Ii State Prison 24427 Musselwhite Dr Waverly, VA - 238910001 |
| Business Phone Number: | 8048342678 |
| Business Fax Number: | 8048342600 |
| Mailing Address: | 12705 Karlyn Ct, CHESTER |
| State: | VA |
| Postal Code: | 238362553 |
| Phone Number: | 8045300906 |
| Fax Number: | 8048342600 |
| NPI Enumeration Date: | 04/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101840437 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |