Provider Demographics
NPI:1285633735
Name:JACOBS, TERESA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5593
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5500
Mailing Address - Country:US
Mailing Address - Phone:425-278-2250
Mailing Address - Fax:425-562-5885
Practice Address - Street 1:1380 112TH AVE NE #307
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:425-278-2250
Practice Address - Fax:425-562-5885
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029806207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117050Medicaid
WAAB34037OtherMEDICARE ID #
WA0538JAOtherREGENCE
WA0538JAOtherREGENCE
WAE24703Medicare UPIN
WAG8868902Medicare UPIN