MEDICARE: MR. ROBERT DARRELL JACOBS

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	3747P1801X	Personal Care Attendant		DC

General Provider Information

NPI Number	:	1336604719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DARRELL JACOBS

Provider Business Mailing Address
First Line	:	2396 ELVANS RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3504
Country	:	US
Telephone Number	:	202-760-8325
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 30TH ST SE APT 213
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1657
Country	:	US
Telephone Number	:	202-241-2168
Fax Number	:

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

Provider Enumeration Date	:	02/09/2019
Last Update Date	:	02/09/2019

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