Provider Demographics
NPI:1609819770
Name:JACOBSTEIN, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:JACOBSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:2411 W BELVEDERE AVE STE 407
Practice Address - Street 2:MORTON MOWER, M.D., MOB
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5231
Practice Address - Country:US
Practice Address - Phone:410-601-8663
Practice Address - Fax:410-601-5389
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0062682080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408097100Medicaid
MD408097100Medicaid
MD170769Medicare PIN