Provider Demographics
NPI:1356491237
Name:SANDS, JACOB MAGEE (MD)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:MAGEE
Last Name:SANDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BURLINGTON MALL RD.
Mailing Address - Street 2:ONCOLOGY DEPARTMENT, LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805
Mailing Address - Country:US
Mailing Address - Phone:781-744-8301
Mailing Address - Fax:781-744-7553
Practice Address - Street 1:41 BURLINGTON MALL RD.
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:916-734-7080
Practice Address - Fax:781-744-7553
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97655207R00000X
MA252674207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093733AMedicaid
MA002951301Medicare PIN