1346385507 NPI number — DR. MATTHEW DAVID JACOBSON M.D.

Table of content: DR. MATTHEW DAVID JACOBSON M.D. (NPI 1346385507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346385507 NPI number — DR. MATTHEW DAVID JACOBSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBSON
Provider First Name:
MATTHEW
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1346385507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 SILVERSIDE RD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19809-1774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-738-5500
Provider Business Mailing Address Fax Number:
302-738-9449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TOTAL CARE PHYSICIANS, OMEGA PROF CENTER, OMEGA DR.
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE 89
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-738-5500
Provider Business Practice Location Address Fax Number:
302-738-9449
Provider Enumeration Date:
02/21/2007

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: 207R00000X , with the licence number:  C1-0008373 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MD5334 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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