Organization
JUDITH L. JACOBUS, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JUDITH L JACOBUS M.D. (OWNER)
(814) 944-8012
Entity
Organization
Contact information
Practice address
1701 12TH AVE. BLDG F, ALTOONA, PA 16601
(814) 944-8012
(814) 944-4852
Mailing address
4200 HAREWOOD RD NE, WASHINGTON, DC 20017-1511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD044442E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012014890005
—
PA
Enumeration date
03/07/2007
Last updated
01/11/2008
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