Provider Demographics
NPI:1124378617
Name:JACOBY, ELAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAD
Middle Name:
Last Name:JACOBY
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 1:1800 ORLEANS STREET
Mailing Address - Street 2:THE BLOOMBERG CHILDREN'S CENTER, ROM 11379
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-8751
Mailing Address - Fax:410-955-0028
Practice Address - Street 1:1800 ORLEANS STREET
Practice Address - Street 2:THE BLOOMBERG CHILDREN'S CENTER, ROM 11379
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-8751
Practice Address - Fax:410-955-0028
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program