Provider Demographics
NPI:1467548792
Name:JACOBSON, EDMON Y (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMON
Middle Name:Y
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 LINCOLN ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8200
Mailing Address - Country:US
Mailing Address - Phone:508-875-5585
Mailing Address - Fax:508-820-0882
Practice Address - Street 1:85 LINCOLN ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8200
Practice Address - Country:US
Practice Address - Phone:508-875-5585
Practice Address - Fax:508-820-0882
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA56601207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3035565Medicaid
MAW65724Medicare UPIN
MA3035565Medicaid