MEDICARE: SARA J JACOBSON 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	208000000X	Pediatrics Physician	227551	MA

General Provider Information

NPI Number	:	1861450785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA J JACOBSON M.D.

Provider Business Mailing Address
First Line	:	105 MILLBURY STREET
Second Line	:
City	:	AUBURN
State	:	MA
Zip	:	01501
Country	:	US
Telephone Number	:	860-242-8330
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 MILLBURY ST
Second Line	:
City	:	AUBURN
State	:	MA
Zip	:	01501-3205
Country	:	US
Telephone Number	:	508-832-9691
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	12/09/2011

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