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General NPI Number Information
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NPI Number | 1649352964
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Entity Type | Individual
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Provider Name | MICHAEL A JACOBSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 1051 LONG RIDGE RD
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City | STAMFORD
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State | CT
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Zip | 06903-4436
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Country | US
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Telephone | 203-329-7960
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Fax | 203-329-7920
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Provider Business Mailing Address
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Address Line | 1051 LONG RIDGE RD
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City | STAMFORD
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State | CT
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Zip | 06903-4436
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Country | US
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Telephone | 203-329-7960
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Fax | 203-329-7920
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | LL27743
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD434064
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 047462
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 260244-1
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License Number State | NY
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