Provider Demographics
NPI:1245233469
Name:JACOBS, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1152
Mailing Address - Country:US
Mailing Address - Phone:610-865-5888
Mailing Address - Fax:610-865-1697
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 602
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:610-865-5888
Practice Address - Fax:610-865-1697
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037424E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000155375601OtherUNITED HEALTHCARE
1521554OtherGATEWAY HEALTH PLAN
40433OtherGEISINGER HEALTH PLAN
PA0011789700002Medicaid
01201301OtherCAPITAL BLUE CROSS
000154067OtherHIGHMARK BLUE SHIELD
NJ0067946Medicaid
20008418OtherAMERIHEALTH MERCY HEALTH
000000129237OtherUNISON HEALTH PLAN
NJ0067946Medicaid
PA390000985Medicare PIN
NJ065038Q79Medicare PIN
0000155375601OtherUNITED HEALTHCARE