Individual
DEASIA DOMINIQUE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 W 7TH ST, FREDERICK, MD 21701-4586
(240) 215-6310
(240) 439-8910
Mailing address
400 W 7TH ST, FREDERICK, MD 21701-4506
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
D93654
MD
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
D93654
MD
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
D0093827
MD
Other
Enumeration date
03/28/2016
Last updated
06/17/2025
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