Individual
JACOB N MBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4257 58TH AVE, BLADENSBURG, MD 20710-1926
(405) 215-0521
Mailing address
4257 58TH AVE, BLADENSBURG, MD 20710-1926
(405) 215-0521
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA0000812684
—
DC
Enumeration date
08/31/2021
Last updated
07/26/2023
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