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General NPI Number Information
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NPI Number | 1487016465
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Entity Type | Individual
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Provider Name | EMILY ALYSON JACOBS D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-0111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 468
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City | SKOWHEGAN
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State | ME
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Zip | 04976-0468
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Country | US
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Telephone | 207-858-8358
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Fax | 207-474-9261
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | DO2893
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | DO2893
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License Number State | ME
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