Healthcare Provider Details

I. General information

NPI: 1124938394
Provider Name (Legal Business Name): JACOB MARLOW THOMSON MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

IV. Provider business mailing address

11 HILLS BEACH RD
BIDDEFORD ME
04005-9526
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7000
  • Fax:
Mailing address:
  • Phone: 404-990-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberDLC5344
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number0107835664MA
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number0107835664MA
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number910594166
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: