Provider Demographics
NPI:1235115221
Name:JACOBSON, MICHELE L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 LITTLE ROCK LN
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3517
Mailing Address - Country:US
Mailing Address - Phone:724-527-9525
Mailing Address - Fax:724-527-9683
Practice Address - Street 1:530 SOUTH ST
Practice Address - Street 2:SUITE G-20
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2775
Practice Address - Country:US
Practice Address - Phone:724-832-9190
Practice Address - Fax:724-832-9190
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H54849Medicare UPIN
054766Medicare ID - Type Unspecified