Healthcare Provider Details

I. General information

NPI: 1700670320
Provider Name (Legal Business Name): BRANDON MICHAEL JACOBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E WEST HWY STE 1418
HYATTSVILLE MD
20782-1916
US

IV. Provider business mailing address

PO BOX 1057
WASHINGTON DC
20013-1057
US

V. Phone/Fax

Practice location:
  • Phone: 929-712-7183
  • Fax:
Mailing address:
  • Phone: 929-712-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number171000000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: