Provider Demographics
NPI:1649352964
Name:JACOBSON, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1051 LONG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-4436
Mailing Address - Country:US
Mailing Address - Phone:203-329-7960
Mailing Address - Fax:203-329-7920
Practice Address - Street 1:1051 LONG RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-4436
Practice Address - Country:US
Practice Address - Phone:203-329-7960
Practice Address - Fax:203-329-7920
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL27743207N00000X
PAMD434064207N00000X
CT047462207ND0101X
NY260244-1207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery