Healthcare Provider Details

I. General information

NPI: 1245233469
Provider Name (Legal Business Name): JOSEPH M JACOBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST SUITE 602
BETHLEHEM PA
18015-1152
US

IV. Provider business mailing address

701 OSTRUM ST SUITE 602
BETHLEHEM PA
18015-1152
US

V. Phone/Fax

Practice location:
  • Phone: 610-865-5888
  • Fax: 610-865-1697
Mailing address:
  • Phone: 610-865-5888
  • Fax: 610-865-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD037424E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0000155375601
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE
# 2
Identifier1521554
Identifier TypeOTHER
Identifier State
Identifier IssuerGATEWAY HEALTH PLAN
# 3
Identifier40433
Identifier TypeOTHER
Identifier State
Identifier IssuerGEISINGER HEALTH PLAN
# 4
Identifier0011789700002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier01201301
Identifier TypeOTHER
Identifier State
Identifier IssuerCAPITAL BLUE CROSS
# 6
Identifier000154067
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BLUE SHIELD
# 7
Identifier0067946
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 8
Identifier20008418
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERIHEALTH MERCY HEALTH
# 9
Identifier000000129237
Identifier TypeOTHER
Identifier State
Identifier IssuerUNISON HEALTH PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: