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General NPI Number Information
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NPI Number | 1457472391
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Entity Type | Organization
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Legal Business Name | JACOB T JOSEPH MD PC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10721 MAIN ST SUITE 1100
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-273-4762
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Fax | 703-591-7719
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Provider Business Mailing Address
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Address Line | 10721 MAIN ST SUITE 1100
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-273-4762
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Fax | 703-591-7719
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB T JOSEPH
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Credential | MD
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Telephone | 703-273-4762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 0101034461
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License Number State | VA
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