Provider Demographics
NPI:1194764209
Name:SOBEL, JASON MAXWELL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MAXWELL
Last Name:SOBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 FAIRVIEW PARK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4583
Mailing Address - Country:US
Mailing Address - Phone:703-538-2066
Mailing Address - Fax:
Practice Address - Street 1:3180 FAIRVIEW PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4583
Practice Address - Country:US
Practice Address - Phone:703-538-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111758207R00000X, 207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-111758Medicaid
IL11796884OtherCAQH
ILK19436Medicare ID - Type UnspecifiedLAKE COUNTY
IL11796884OtherCAQH
IL036-111758Medicaid