Provider Demographics
NPI:1356968408
Name:JACOB, JOANNA SARAH (MBBS)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:SARAH
Last Name:JACOB
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8571 CASTLEMILL CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2606
Mailing Address - Country:US
Mailing Address - Phone:531-777-3904
Mailing Address - Fax:
Practice Address - Street 1:8901 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2603
Practice Address - Country:US
Practice Address - Phone:410-661-4670
Practice Address - Fax:410-661-4671
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8718207Q00000X
MDD96928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine