MEDICARE: DR. JOHN DOROMAL JACOB M.D.

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	2086S0102X	Surgical Critical Care Physician	308671	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	308671	NY
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD454429	PA
4	2086S0102X	Surgical Critical Care Physician	MD454429	PA
5	208600000X	Surgery Physician	MD454429	PA

General Provider Information

NPI Number	:	1801182662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DOROMAL JACOB M.D.

Provider Business Mailing Address
First Line	:	1245 HIGHLAND AVE BLDG SUITE401
Second Line	:
City	:	ABINGTON
State	:	PA
Zip	:	19001-3714
Country	:	US
Telephone Number	:	215-481-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	834 WALNUT ST STE 650
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5109
Country	:	US
Telephone Number	:	215-955-6996
Fax Number	:	215-923-6003

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	05/12/2026

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Directions to “ DR. JOHN DOROMAL JACOB M.D.” Practice Location

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