Provider Demographics
NPI:1922086487
Name:LAUBACH, JACOB P (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:P
Last Name:LAUBACH
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 1:44 BINNEY ST
Mailing Address - Street 2:D1B30
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-2127
Mailing Address - Fax:617-632-6624
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:D1B30
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-2127
Practice Address - Fax:617-632-6624
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101572207R00000X
MA236121207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13186OtherBLUE CROSS BLUE SHIELD
NC7913186Medicaid
NC7913186Medicaid
H69002Medicare UPIN
NC2004851AMedicare ID - Type Unspecified