Provider Demographics
NPI:1912293184
Name:JACOB, CIMY SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CIMY
Middle Name:SUSAN
Last Name:JACOB
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Gender:F
Credentials:MD
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Mailing Address - Street 1:UPMC CHILDRENS SPECIALIST- NEUROLOGY
Mailing Address - Street 2:3 WALNUT STREET, SUITE 205
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1168
Mailing Address - Country:US
Mailing Address - Phone:717-988-0090
Mailing Address - Fax:717-221-5320
Practice Address - Street 1:UPMC CHILDRENS SPECIALIST- NEUROLOGY
Practice Address - Street 2:3 WALNUT STREET, SUITE 205
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1168
Practice Address - Country:US
Practice Address - Phone:717-988-0090
Practice Address - Fax:717-221-5320
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2021-10-13
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Provider Licenses
StateLicense IDTaxonomies
PAMD4753182084N0402X
DEC1-00109602084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology