Provider Demographics
NPI:1639340722
Name:JACOB, RON MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:MATHEW
Last Name:JACOB
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2441
Mailing Address - Fax:
Practice Address - Street 1:30 MONUMENT RD # 1100
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5024
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-851-3521
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420245207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021930250001Medicaid
PA068212Medicare PIN
PAH80315Medicare UPIN