Provider Demographics
NPI:1871880138
Name:JACOB-LEONCE, MARISA (MD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:JACOB-LEONCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVENUE
Mailing Address - Street 2:BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-4135
Mailing Address - Fax:585-273-3637
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:5232 RCP
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1007
Practice Address - Country:US
Practice Address - Phone:319-467-5193
Practice Address - Fax:319-384-8054
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316592207R00000X, 207ZP0102X
IAR9290207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine