Provider Demographics
NPI:1457919797
Name:ANJUM, JACOB
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:ANJUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WEST RD.
Mailing Address - Street 2:STE. 202A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2300
Mailing Address - Country:US
Mailing Address - Phone:410-211-0580
Mailing Address - Fax:
Practice Address - Street 1:113 WEST RD.
Practice Address - Street 2:STE. 202A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2300
Practice Address - Country:US
Practice Address - Phone:410-337-3697
Practice Address - Fax:410-321-0580
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health