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NPI Code Detail

MEDICARE: DR. SHALINI MARY JACOB M.D., MRCP, FACP

MEDICARE: DR. SHALINI MARY JACOB M.D., MRCP, FACP
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
1207R00000XInternal Medicine PhysicianMD00036705WA
2208M00000XHospitalist Physician27907OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144206038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHALINI MARY JACOB M.D., MRCP, FACP
Provider Business Mailing Address
First Line : PO BOX 3360
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3360
Country : US
Telephone Number : 866-747-2455
Fax Number :
Provider Business Practice Location Address
First Line : 413 LILLY RD NE
Second Line : PMG SW WA PSPH HOSPITALISTS
City : OLYMPIA
State : WA
Zip : 98506-5133
Country : US
Telephone Number : 360-493-4069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 06/01/2021

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