Provider Demographics
NPI:1235256827
Name:JACOBSEN, FREDERICK MARIUS IV (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MARIUS
Last Name:JACOBSEN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:908 NEW HAMPSHIRE AVE NW STE 700
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2371
Mailing Address - Country:US
Mailing Address - Phone:202-234-1742
Mailing Address - Fax:
Practice Address - Street 1:908 NEW HAMPSHIRE AVE NW STE 700
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2371
Practice Address - Country:US
Practice Address - Phone:202-234-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC147012083P0901X, 2084N0400X, 2084P0800X, 2084P0805X, 2084S0012X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC88024Medicare UPIN