Individual
JESSICA DELORES JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3700 ODONNELL ST, BALTIMORE, MD 21224-5269
(773) 292-4800
(312) 564-4059
Mailing address
1340 S DAMEN AVE, SUITE 400, CHICAGO, IL 60608-1169
(773) 292-4800
(312) 564-4059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MT194489
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RES0000
MEDICARE UPIN FOR RESIDENCY PROGRAM
PA
Enumeration date
06/04/2009
Last updated
10/13/2020
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