Provider Demographics
NPI:1336588136
Name:JACOBSON, REBECCA KHEZRI (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KHEZRI
Last Name:JACOBSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 600736
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-0007
Mailing Address - Country:US
Mailing Address - Phone:617-540-5570
Mailing Address - Fax:617-540-5571
Practice Address - Street 1:85 LINCOLN ST STE 510
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8200
Practice Address - Country:US
Practice Address - Phone:617-540-5570
Practice Address - Fax:617-540-5571
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462041207N00000X, 207ND0101X
MA290216207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery