MEDICARE: DR. KENNETH L JACOBSON MD

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	207Q00000X	Family Medicine Physician	MD044751E	PA

General Provider Information

NPI Number	:	1811993363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L JACOBSON MD

Provider Business Mailing Address
First Line	:	1820 BETHLEHEM PIKE
Second Line	:
City	:	FLOURTOWN
State	:	PA
Zip	:	19031-1504
Country	:	US
Telephone Number	:	215-836-1354
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E CATHEDRAL RD STE 11
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	267-766-6321
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/09/2023

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