Provider Demographics
NPI:1942795349
Name:MAHER, JACOB THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:THOMAS
Last Name:MAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4969 BENCHMARK CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8928
Mailing Address - Country:US
Mailing Address - Phone:618-235-2311
Mailing Address - Fax:618-589-3335
Practice Address - Street 1:4969 BENCHMARK CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8928
Practice Address - Country:US
Practice Address - Phone:618-235-2311
Practice Address - Fax:618-589-3335
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036160745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics