MEDICARE: MATTHEW JACOB 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RI0200X	Infectious Disease Physician	C1-0029436	DE

General Provider Information

NPI Number	:	1689373169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JACOB MD

Provider Business Mailing Address
First Line	:	1515 SAVANNAH RD FL 2
Second Line	:
City	:	LEWES
State	:	DE
Zip	:	19958-1675
Country	:	US
Telephone Number	:	302-645-3499
Fax Number	:	302-644-4830

Provider Business Practice Location Address
First Line	:	1535 SAVANNAH RD
Second Line	:
City	:	LEWES
State	:	DE
Zip	:	19958-1964
Country	:	US
Telephone Number	:	302-645-3232
Fax Number	:	888-987-4578

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	06/02/2026

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Directions to “ MATTHEW JACOB MD” Practice Location

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