Provider Demographics
NPI:1942282041
Name:JACOBSON, JOSEPH O (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:O
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:DANA-FARBER CANCER INSTITUTE, D1234
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-3468
Mailing Address - Fax:617-632-5786
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:DANA-FARBER CANCER INSTITUTE, D1234
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3468
Practice Address - Fax:617-632-5786
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA48077207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B74852Medicare UPIN