Healthcare Provider Details

I. General information

NPI: 1710957444
Provider Name (Legal Business Name): JACOB W. AARONSON D.O., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/27/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 SHERIDAN ST # 245
HOLLYWOOD FL
33020-2275
US

IV. Provider business mailing address

1722 SHERIDAN ST # 245
HOLLYWOOD FL
33020-2275
US

V. Phone/Fax

Practice location:
  • Phone: 240-731-6929
  • Fax: 703-783-0099
Mailing address:
  • Phone: 407-316-9292
  • Fax: 703-783-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number0102201600
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: