Provider Demographics
NPI:1629572219
Name:DANOFF, JACOB SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:SCOTT
Last Name:DANOFF
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 1:110 SOUTH PACA STREET
Mailing Address - Street 2:6TH FLOOR, STE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2216
Mailing Address - Country:US
Mailing Address - Phone:410-328-8025
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH PACA STREET
Practice Address - Street 2:6TH FLOOR, STE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2120
Practice Address - Country:US
Practice Address - Phone:410-328-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173633207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program