Provider Demographics
NPI:1497799076
Name:JACOBS, DOUGLAS GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GEORGE
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:PROFESSIONAL PSYCHIATRIC ASSOC
Mailing Address - Street 2:33 LILLIAN WAY
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:781-591-5221
Mailing Address - Fax:781-235-6390
Practice Address - Street 1:PROFESSIONAL PSYCHIATRIC ASSOC
Practice Address - Street 2:33 LILLIAN WAY
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:781-591-5221
Practice Address - Fax:781-235-6390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95180Medicare UPIN
MAC04606Medicare ID - Type Unspecified