Provider Demographics
NPI:1396774931
Name:JACOBSON, MITCHELL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:SCOTT
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2910
Mailing Address - Country:US
Mailing Address - Phone:978-531-0677
Mailing Address - Fax:978-531-5676
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 306
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-531-0677
Practice Address - Fax:978-531-5676
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-17
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Provider Licenses
StateLicense IDTaxonomies
MA150166207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3178102Medicaid
MA3178102Medicaid
MAG36716Medicare UPIN