MEDICARE: JACOB TRACHTENBERG 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	2084P0805X	Geriatric Psychiatry Physician	MD014012E	PA
2	2084P0800X	Psychiatry Physician	MD014012E	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	:	1518073915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB TRACHTENBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 478
Second Line	:
City	:	VILLANOVA
State	:	PA
Zip	:	19085-0478
Country	:	US
Telephone Number	:	610-527-0511
Fax Number	:	610-270-2308

Provider Business Practice Location Address
First Line	:	559 W GERMANTOWN PIKE
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-4250
Country	:	US
Telephone Number	:	484-622-1695
Fax Number	:	484-622-4259

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/22/2019

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