Provider Demographics
NPI:1316928641
Name:JACOBS, HOWARD TERRY (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:TERRY
Last Name:JACOBS
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 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-484-5686
Mailing Address - Fax:410-484-6472
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-484-5686
Practice Address - Fax:410-484-6472
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD28792207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400281400Medicaid
MD400281400Medicaid
MDKP24JAMedicare ID - Type Unspecified