Individual
ALICE K JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
732 HARRISON AVE, 3RD FLOOR, BOSTON, MA 02118-2309
(617) 638-7490
(617) 414-8742
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49246
MA
207RC0000X
Cardiovascular Disease Physician
Primary
49246
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110005324A
—
MA
Enumeration date
12/22/2005
Last updated
06/13/2014
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