Individual
DR. KENNETH M JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 S WASHINGTON AVE STE 1000, SCRANTON, PA 18505-3814
(570) 941-0630
(570) 343-3923
Mailing address
501 S WASHINGTON AVE STE 1000, SCRANTON, PA 18505-3814
(570) 941-0630
(570) 343-3923
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD028455E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009048400001
—
PA
Enumeration date
07/31/2006
Last updated
12/14/2020
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