Provider Demographics
NPI:1639157878
Name:DRUCKER, JACOB R (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:R
Last Name:DRUCKER
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 1:225 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1815
Mailing Address - Country:US
Mailing Address - Phone:757-452-3480
Mailing Address - Fax:757-452-3482
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-452-3480
Practice Address - Fax:757-452-3482
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024560208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
146541OtherANTHEM BC/BS
VA227938OtherANTHEM BC BS
VA007501668Medicaid
VA15315OtherSENTARA HEALTHCARE
VA007501668Medicaid
VA340000486Medicare ID - Type Unspecified
D76088Medicare UPIN
VA340012055Medicare ID - Type UnspecifiedRAILROAD MEDICARE