Provider Demographics
NPI:1073584272
Name:JACOBS, SAMUEL A (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
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 1:5115 CENTRE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1301
Mailing Address - Country:US
Mailing Address - Phone:412-235-1020
Mailing Address - Fax:412-235-1030
Practice Address - Street 1:5115 CENTRE AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1301
Practice Address - Country:US
Practice Address - Phone:412-235-1020
Practice Address - Fax:412-235-1030
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017709E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28919Medicare UPIN
PA070286Medicare ID - Type Unspecified