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NPI Code Detail

MEDICARE: JACOB R. DRUCKER MD

MEDICARE: JACOB R. DRUCKER 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
1208800000XUrology Physician0101024560VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1146541OTHERANTHEM BC/BS
2227938OTHERVAANTHEM BC BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
415315OTHERVASENTARA HEALTHCARE

General Provider Information

NPI Number : 1639157878
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB R. DRUCKER MD
Provider Business Mailing Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-452-3480
Fax Number : 757-452-3482
Provider Business Practice Location Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-452-3480
Fax Number : 757-452-3482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 11/27/2013

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