Provider Demographics
NPI:1760672117
Name:JACOBS, JERALYN BERNIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JERALYN
Middle Name:BERNIER
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JERALYN
Other - Middle Name:A
Other - Last Name:BERNIER JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1909 CARROLLTON RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-6243
Mailing Address - Country:US
Mailing Address - Phone:443-758-8116
Mailing Address - Fax:410-571-7302
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-571-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043832208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF48584Medicare UPIN