Provider Demographics
NPI:1396797023
Name:JACOBS, BRIAN R (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
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 1:1909 CARROLLTON RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-6243
Mailing Address - Country:US
Mailing Address - Phone:410-757-1960
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:CMIO
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2978
Practice Address - Country:US
Practice Address - Phone:202-884-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-69782080P0203X
DCMD0362972080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine