MEDICARE: DR. DOUGLAS JACOBSTEIN 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
1	2080P0206X	Pediatric Gastroenterology Physician	D006268	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1609819770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JACOBSTEIN M.D.

Provider Business Mailing Address
First Line	:	2401 W BELVEDERE AVE
Second Line	:	ATTN: CREDENTIALING
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5216
Country	:	US
Telephone Number	:	410-601-5524
Fax Number	:	410-601-8946

Provider Business Practice Location Address
First Line	:	2411 W BELVEDERE AVE STE 407
Second Line	:	MORTON MOWER, M.D., MOB
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5231
Country	:	US
Telephone Number	:	410-601-8663
Fax Number	:	410-601-5389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/03/2010

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Directions to “ DR. DOUGLAS JACOBSTEIN M.D.” Practice Location

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