MEDICARE: DR. MICHAEL JACOBY 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	207L00000X	Anesthesiology Physician	279663	NY
2	390200000X	Student in an Organized Health Care Education/Training Program	MT197673	PA

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

General Provider Information

NPI Number	:	1255652772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JACOBY M.D.

Provider Business Mailing Address
First Line	:	11781 LEE JACKSON MEMORIAL HWY
Second Line	:	SUITE 550
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3309
Country	:	US
Telephone Number	:	571-777-5102
Fax Number	:	703-563-6256

Provider Business Practice Location Address
First Line	:	100 WOODS RD
Second Line	:
City	:	VALHALLA
State	:	NY
Zip	:	22033-3309
Country	:	US
Telephone Number	:	914-493-2844
Fax Number	:	703-563-6256

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	12/14/2015

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Directions to “ DR. MICHAEL JACOBY M.D.” Practice Location

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