Provider Demographics
NPI:1073572509
Name:JACOBS, RICHARD PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PATRICK
Last Name:JACOBS
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 1:5200 CENTRE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1300
Mailing Address - Country:US
Mailing Address - Phone:412-681-6632
Mailing Address - Fax:412-681-8760
Practice Address - Street 1:5200 CENTRE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1300
Practice Address - Country:US
Practice Address - Phone:412-681-6632
Practice Address - Fax:412-681-8760
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013106E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000884425 0002Medicaid
PAJA135114OtherPA BLUE SHIELD
PA000884425 0002Medicaid
PA277480Medicare PIN
PA000135114Medicare PIN