Provider Demographics
NPI:1205153020
Name:JACOBS, JOSEPH JAMES (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:JACOBS
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 1:2801 NEW MEXICO AVE NW
Mailing Address - Street 2:APT. 1411
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 NEW MEXICO AVE NW
Practice Address - Street 2:APT. 1411
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3921
Practice Address - Country:US
Practice Address - Phone:202-944-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0009397208000000X
MDD30788208000000X
PAMD-028632-E208000000X
NJ25MA07882100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics