Provider Demographics
NPI:1801182662
Name:JACOB, JOHN DOROMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOROMAL
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1245 HIGHLAND AVE BLDG SUITE401
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-481-6070
Mailing Address - Fax:
Practice Address - Street 1:834 WALNUT ST STE 650
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-955-6996
Practice Address - Fax:215-923-6003
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD454429208600000X, 2086S0102X, 208G00000X
NY3086712086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care