Provider Demographics
NPI:1801096029
Name:DUBROFF, JACOB G (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:G
Last Name:DUBROFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:1 SILVERSTEIN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3005
Mailing Address - Fax:215-662-7011
Practice Address - Street 1:3400 CIVIC CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-662-3005
Practice Address - Fax:215-662-7011
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2015-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1894042085N0904X
PAMD4401062085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology