Provider Demographics
NPI:1124204912
Name:JACOB CHERIAN MD LLC
Entity Type:Organization
Organization Name:JACOB CHERIAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/INTERNIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-964-5311
Mailing Address - Street 1:10910 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 105R
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3078
Mailing Address - Country:US
Mailing Address - Phone:410-964-5311
Mailing Address - Fax:410-964-8578
Practice Address - Street 1:10910 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 105R
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3078
Practice Address - Country:US
Practice Address - Phone:410-964-5311
Practice Address - Fax:410-964-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50973261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780011800Medicaid
MD009NMedicare PIN
MD780011800Medicaid