Provider Demographics
NPI:1285617498
Name:JACOB, GILLIAN ALTHEA (MD)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:ALTHEA
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:161 FORT EVANS RD NE
Practice Address - Street 2:SUITE 320
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3369
Practice Address - Country:US
Practice Address - Phone:703-777-5111
Practice Address - Fax:703-777-8465
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-10-30
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Provider Licenses
StateLicense IDTaxonomies
VA0101238135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI39702Medicare UPIN
MD017799S40Medicare ID - Type Unspecified