Provider Demographics
NPI:1528027059
Name:JACOBSON, NEIL A (DO)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:100 NEAL AVE
Mailing Address - City:MARION CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15759
Mailing Address - Country:US
Mailing Address - Phone:724-397-5571
Mailing Address - Fax:724-397-2800
Practice Address - Street 1:100 NEAL AVE
Practice Address - Street 2:
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759
Practice Address - Country:US
Practice Address - Phone:724-397-5571
Practice Address - Fax:724-397-2800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003790L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008950530001Medicaid
PA417152OtherHIGHMARK
PA417152OtherHIGHMARK
PA0008950530001Medicaid