Provider Demographics
NPI:1346385507
Name:JACOBSON, MATTHEW DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:405 SILVERSIDE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1774
Mailing Address - Country:US
Mailing Address - Phone:302-738-5500
Mailing Address - Fax:302-738-9449
Practice Address - Street 1:TOTAL CARE PHYSICIANS, OMEGA PROF CENTER, OMEGA DR.
Practice Address - Street 2:BUILDING B, SUITE 89
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-738-5500
Practice Address - Fax:302-738-9449
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-02-02
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0008373207R00000X
DEMD5334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
022005T76Medicare UPIN