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NPI Code Detail

MEDICARE: MRS. TAO NAN CHIA JACOBSON PA-C

MEDICARE: MRS. TAO NAN CHIA JACOBSON PA-C
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
1363AM0700XMedical Physician AssistantMA053658PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11084212OTHERPANCCPA
2OA002319OTHERPAOSTEOPATHIC PHYSICIAN ASSISTANT
3MA053658OTHERPAMEDICAL PHYSICIAN ASSISTANT

General Provider Information

NPI Number : 1164670923
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAO NAN CHIA JACOBSON PA-C
Provider Business Mailing Address
First Line : 2100 MACK BLVD FL 4
Second Line :
City : ALLENTOWN
State : PA
Zip : 18103-5622
Country : US
Telephone Number : 484-884-0469
Fax Number :
Provider Business Practice Location Address
First Line : 1337 BLUE VALLEY DR STE 8
Second Line :
City : PEN ARGYL
State : PA
Zip : 18072-1815
Country : US
Telephone Number : 610-654-1230
Fax Number : 610-654-1232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2008
Last Update Date : 07/21/2022

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Directions to “ MRS. TAO NAN CHIA JACOBSON PA-C” Practice Location

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