Provider Demographics
NPI:1669531216
Name:JACOBS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JACOBS
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 1:1050 LINCOLN WAY
Mailing Address - Street 2:SUITE 8, PAINTER BUILDING
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 LINCOLN WAY
Practice Address - Street 2:SUITE 8, PAINTER BUILDING
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-1442
Practice Address - Country:US
Practice Address - Phone:412-673-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028626L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
251410341OtherBANKERS LIFE AND CASUALIT
251410341OtherAMERIHEALTH
251410341OtherBAKERY AND CONFECTIONARY
19031OtherBCBS OF PENNSYLVANIA
251410341OtherBOILERMAKERS NATIONAL HEA
251410341OtherCAREPLUS HEALTH PLAN FL
101381OtherBEST HEALTH CARE
1620872OtherBCBS OF PENNSYLVANIA
1620872OtherBCBS OUT OF STATE PA
251410341OtherAARP
251410341OtherAMERICAN PROGRESSIVE HEAL
PA000615623001Medicaid
251410341OtherAPWU HEALTH PLAN
19031OtherBSBC OUT OF STATE PA
0077338OtherAETNA
225873OtherADVANTRA
251410341OtherAC UAW RETIREE TRUST
251410341OtherCIGNA
1620872OtherBCBS OF PENNSYLVANIA
251410341OtherBANKERS LIFE AND CASUALIT