MEDICARE: DR. JACOB CEDARBAUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1013439	MA

General Provider Information

NPI Number	:	1144789009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB CEDARBAUM MD

Provider Business Mailing Address
First Line	:	55 FRUIT ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2696
Country	:	US
Telephone Number	:	847-404-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 FRUIT ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2621
Country	:	US
Telephone Number	:	847-404-4326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	12/29/2025

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