Individual
LISA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-0400
Mailing address
PO BOX 64563, BALTIMORE, MD 21264-4563
(443) 287-2778
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
D61193
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
404182800
—
MD
Enumeration date
06/06/2006
Last updated
02/08/2013
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