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General NPI Number Information
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NPI Number | 1811637242
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Entity Type | Organization
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Legal Business Name | ALPHA TELEMEDICINE, PC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 555 BRYANT ST STE 814
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City | PALO ALTO
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State | CA
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Zip | 94301-1704
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Country | US
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Telephone | 415-663-5584
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Fax | 844-640-3975
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Provider Business Mailing Address
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Address Line | 555 BRYANT ST STE 814
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City | PALO ALTO
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State | CA
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Zip | 94301-1704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MARY THERESE JACOBSON
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Credential | MD
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Telephone | 415-663-5584
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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