Healthcare Provider Details

I. General information

NPI: 1316747652
Provider Name (Legal Business Name): JACOB SAMUEL MCCANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 5TH AVE STE 9
PITTSBURGH PA
15213-3236
US

IV. Provider business mailing address

3600 FORBES AVE FORBES TOWER; PLAZA LEVEL SUITE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT236768
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: