Healthcare Provider Details

I. General information

NPI: 1689127797
Provider Name (Legal Business Name): THOMAS N JACOB MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR STE 240
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

1635 N GEORGE MASON DR STE 240
ARLINGTON VA
22205-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-8294
  • Fax: 703-522-4915
Mailing address:
  • Phone: 703-522-8294
  • Fax: 703-522-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number101029299
License Number StateVA

VIII. Authorized Official

Name: DR. THOMAS JACOB
Title or Position: OWNER
Credential: MD
Phone: 703-522-8294