Healthcare Provider Details

I. General information

NPI: 1215381462
Provider Name (Legal Business Name): JACOB ALLAIRE BREMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DULANEY VALLEY RD STE 616
TOWSON MD
21204-2685
US

IV. Provider business mailing address

9600 BLACKWELL RD STE 500
ROCKVILLE MD
20850-3783
US

V. Phone/Fax

Practice location:
  • Phone: 410-512-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR.0073569
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number26069
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number61588010
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101274796
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number74572
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0107165
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA198102
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD221619
License Number StateOR
# 9
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD600006213
License Number StateDC
# 10
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD495961
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: