Provider Demographics
NPI:1154478915
Name:JACOBSEN, TRICIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:A
Last Name:JACOBSEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:491 GOLD STAR HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6226
Mailing Address - Country:US
Mailing Address - Phone:860-445-5107
Mailing Address - Fax:860-448-1368
Practice Address - Street 1:491 GOLD STAR HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6226
Practice Address - Country:US
Practice Address - Phone:860-445-5107
Practice Address - Fax:860-448-1368
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-02-01
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Provider Licenses
StateLicense IDTaxonomies
CT045007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology