Provider Demographics
NPI:1396030417
Name:ANKENY, JACOB THOMAS (MD, MPH, MBA)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:THOMAS
Last Name:ANKENY
Suffix:
Gender:M
Credentials:MD, MPH, MBA
Other - Prefix:
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Mailing Address - Street 1:520 BEECHER STOWE ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1299
Mailing Address - Country:US
Mailing Address - Phone:832-913-9467
Mailing Address - Fax:
Practice Address - Street 1:212 WALLACE CREEK RD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-450-8330
Practice Address - Fax:910-449-8408
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012523422083X0100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery