Provider Demographics
NPI:1689625709
Name:JACOBS, DEBORAH S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 HILLSIDE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1227
Mailing Address - Country:US
Mailing Address - Phone:781-726-7333
Mailing Address - Fax:781-726-7310
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:781-726-7333
Practice Address - Fax:781-726-7310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74006207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3078795Medicaid
MA074006OtherTUFTS
MAJ11297OtherBCBS
MAAA58791OtherHPHC
MAJ11297Medicare ID - Type Unspecified
MAAA58791OtherHPHC