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General NPI Number Information
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NPI Number | 1477043248
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Entity Type | Individual
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Provider Name | JOBY CHACKO JACOB MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 1411 WOODBOURNE RD
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City | LEVITTOWN
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State | PA
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Zip | 19057-1540
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Country | US
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Telephone | 215-943-2000
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Fax | 215-943-4439
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Provider Business Mailing Address
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Address Line | PO BOX 7410725
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City | CHICAGO
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State | IL
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Zip | 60674-0725
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Country | US
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Telephone | 215-943-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD474033
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT216142
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License Number State | PA
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