Provider Demographics
NPI:1114994381
Name:JACOBSON, SETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:M
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 CANAL VIEW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2808
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-242-9663
Practice Address - Street 1:140 CANAL VIEW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2808
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-242-9663
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205422207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002135471OtherUNITED HEALTHCARE
NY02153964Medicaid
060062940OtherRAILROAD MEDICARE
7700317OtherAETNA
7701230OtherMVP
MDG121OtherPREFERRED CARE
301127OtherWELLCARE
9682190OtherGHI
000526915001OtherHEALTH NOW PARNALL
PO10205422OtherGRIPA
PO10205422OtherEXCELLUS
000526915001OtherCOMM BLUE/BCBSWNY
RC60205422OtherRCIPA
000526915002OtherHEALTH NOW LINDEN
6890OtherBCBS
MDG121OtherPREFERRED CARE
CC5981Medicare ID - Type UnspecifiedPART B