1386845022 NPI number — DR. MICAH ABRAM JACOBS MD

Table of content: DR. MICAH ABRAM JACOBS MD (NPI 1386845022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386845022 NPI number — DR. MICAH ABRAM JACOBS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
MICAH
Provider Middle Name:
ABRAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386845022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9104 BABCOCK BLVD
Provider Second Line Business Mailing Address:
SUITE 6118
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-348-0330
Provider Business Mailing Address Fax Number:
412-348-0338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9104 BABCOCK BLVD
Provider Second Line Business Practice Location Address:
SUITE 6118
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-348-0330
Provider Business Practice Location Address Fax Number:
412-348-0338
Provider Enumeration Date:
05/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  MD433626 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0200X , with the licence number: 57.007172 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)