MEDICARE: DR. JASON MAXWELL SOBEL M.D.

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	036-111758	IL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036-111758	IL
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	036-111758	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11796884	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1194764209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MAXWELL SOBEL M.D.

Provider Business Mailing Address
First Line	:	3180 FAIRVIEW PARK DR STE 500
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-4583
Country	:	US
Telephone Number	:	703-538-2066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 FAIRVIEW PARK DR STE 500
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-4583
Country	:	US
Telephone Number	:	703-538-2066
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	05/15/2024

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Directions to “ DR. JASON MAXWELL SOBEL M.D.” Practice Location

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