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NPI Code Detail

MEDICARE: DR. MARSHALL LEWIS JACOBS M.D.

MEDICARE:  DR. MARSHALL LEWIS JACOBS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMD045029EPA

General Provider Information

NPI Number : 1053360560
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARSHALL LEWIS JACOBS M.D.
Provider Business Mailing Address
First Line : FRONT STREET AND ERIE AVENUE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-1095
Country : US
Telephone Number : 215-429-5109
Fax Number : 215-427-3860
Provider Business Practice Location Address
First Line : FRONT STREET AND ERIE AVENUE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-1095
Country : US
Telephone Number : 215-429-5109
Fax Number : 215-427-3860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARSHALL LEWIS JACOBS M.D.” Practice Location

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