Provider Demographics
NPI:1225351042
Name:JACOBS, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MPH
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-0003
Mailing Address - Country:US
Mailing Address - Phone:781-899-9774
Mailing Address - Fax:781-899-9774
Practice Address - Street 1:251 SUNSET RD.
Practice Address - Street 2:
Practice Address - City:FITZWILLIAM
Practice Address - State:NH
Practice Address - Zip Code:03447
Practice Address - Country:US
Practice Address - Phone:617-276-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT178835208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice