Provider Demographics
NPI:1598433385
Name:JABCO, NICHOLAS ADAM
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ADAM
Last Name:JABCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-7540
Mailing Address - Country:US
Mailing Address - Phone:814-470-0253
Mailing Address - Fax:
Practice Address - Street 1:11804 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3311
Practice Address - Country:US
Practice Address - Phone:410-870-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty