Provider Demographics
NPI:1235176942
Name:JACOBS, BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 PARKWAY CTR
Mailing Address - Street 2:SUITE 375
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3704
Mailing Address - Country:US
Mailing Address - Phone:412-937-5700
Mailing Address - Fax:412-937-5739
Practice Address - Street 1:1 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1601
Practice Address - Country:US
Practice Address - Phone:610-408-0822
Practice Address - Fax:610-408-9187
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043853L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD80690Medicare UPIN