Provider Demographics
NPI:1841249588
Name:JACOB, MARIA AGUIAR (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:AGUIAR
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:A
Other - Last Name:AGUIAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:601 CHILDREN'S LANE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-668-7275
Mailing Address - Fax:757-668-9175
Practice Address - Street 1:601 CHILDREN'S LANE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7275
Practice Address - Fax:757-668-9175
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051597207ZP0213X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017103130001Medicaid
NC890640ZMedicaid
MD149601800Medicaid
DE0000980801Medicaid
VA006603378Medicaid
WV2002484000Medicaid
VA220000617Medicare ID - Type Unspecified
WV2002484000Medicaid