MEDICARE: NICHOLAS ADAM JABCO

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1598433385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ADAM JABCO

Provider Business Mailing Address
First Line	:	134 LIMESTONE DR
Second Line	:
City	:	BELLEFONTE
State	:	PA
Zip	:	16823-7540
Country	:	US
Telephone Number	:	814-470-0253
Fax Number	:

Provider Business Practice Location Address
First Line	:	11804 REISTERSTOWN RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-3311
Country	:	US
Telephone Number	:	410-870-5094
Fax Number	:

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

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	09/06/2021

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Directions to “ NICHOLAS ADAM JABCO ” Practice Location

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