Provider Demographics
NPI:1598751356
Name:JACOBS, ROBYN W (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:W
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18 JUSTIN MORRILL MEM HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH STRAFFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05070-7700
Mailing Address - Country:US
Mailing Address - Phone:603-448-7344
Mailing Address - Fax:603-448-7077
Practice Address - Street 1:18 JUSTIN MORRILL MEM HWY
Practice Address - Street 2:
Practice Address - City:SOUTH STRAFFORD
Practice Address - State:VT
Practice Address - Zip Code:05070-7700
Practice Address - Country:US
Practice Address - Phone:603-448-7344
Practice Address - Fax:603-448-7077
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008543Medicaid
NH30202100Medicaid
NHH69270Medicare UPIN
NHRE6887Medicare ID - Type Unspecified