Provider Demographics
NPI:1467418111
Name:JACOBS, STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:JACOBS
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 1:424 BEN OAKS DR E
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2217
Mailing Address - Country:US
Mailing Address - Phone:410-215-8900
Mailing Address - Fax:410-766-0881
Practice Address - Street 1:424 BEN OAKS DR E
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-215-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI549207RC0200X
MDD22483207RC0200X, 208M00000X
MDD0022483207RP1001X
IN01083037A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
129242OtherUHC RENDERING
58184 38184OtherMAMSI RENDERING
4069628OtherAETNA RENDERING
4800019OtherAMERIGROUP RENDERING
1344238OtherCIGNA RENDERING
1431OtherELDERHEALTH RENDERING
MD310641100Medicaid
290008295OtherRR MEDICARE RENDERING
32582512OtherBCBS MD RENDERING
J4660002OtherBCBS DC RENDERING
4800019OtherAMERIGROUP RENDERING
D76862Medicare UPIN
KS04M554Medicare PIN