Provider Demographics
NPI:1063409712
Name:JACOBSON, MARTIN AARON (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:AARON
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1836
Mailing Address - Country:US
Mailing Address - Phone:610-921-2094
Mailing Address - Fax:610-921-1235
Practice Address - Street 1:4201 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560-1836
Practice Address - Country:US
Practice Address - Phone:610-921-2094
Practice Address - Fax:610-921-1235
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA020798E MD207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
024056G5BMedicare ID - Type Unspecified
412170Medicare ID - Type UnspecifiedGRP #
C27767Medicare UPIN