Provider Demographics
NPI:1396826608
Name:JACOBSON, ALAN MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARC
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:47 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1003
Mailing Address - Country:US
Mailing Address - Phone:617-226-5810
Mailing Address - Fax:617-226-5805
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-732-2594
Practice Address - Fax:617-226-5805
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA329532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA32953OtherSTATE LICENSE