Individual
DR. ELIZABETH S JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD12366
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007059436
RI MEDICARE
RI
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
07/24/2007
BCBS
RI
01
—
09/13/2007
NHPRI
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
05
—
1871516
—
RI
01
—
1871516963
NPI
RI
05
—
2135001
—
MA
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/26/2006
Last updated
02/12/2010
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