Provider Demographics
NPI:1891769899
Name:JACOBY, JEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:
Last Name:JACOBY
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:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1754
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:CEDAR CREST & I-78
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105
Practice Address - Country:US
Practice Address - Phone:610-402-8130
Practice Address - Fax:610-402-7160
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417149207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA930125852OtherRR MEDICARE
PA0018872250005Medicaid
PA0018872250007Medicaid
PAJA1369121OtherBLUE SHIELD
PAH57512Medicare UPIN
PA055930N46Medicare PIN
PA0018872250007Medicaid