Individual
DR. LISA MARIA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
675 BALTIMORE DRIVE, WILKES BARRE, PA 18702-3306
(570) 808-6400
(570) 808-6338
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
24109
WV
208200000X
Plastic Surgery Physician
25MA08245300
NJ
208200000X
Plastic Surgery Physician
Primary
MD452576
PA
Other
Enumeration date
08/08/2007
Last updated
08/11/2020
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