Provider Demographics
NPI:1811094261
Name:JOSEPH, JACOB (MBBS, MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MBBS, MD
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Mailing Address - Street 1:1400 VFW PARKWAY
Mailing Address - Street 2:CARDIOLOGY SECTION (111), VABHS
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:857-203-6841
Mailing Address - Fax:857-203-5550
Practice Address - Street 1:1400 VFW PARKWAY
Practice Address - Street 2:CARDIOLOGY SECTION (111), VABHS
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:857-203-6841
Practice Address - Fax:857-203-5550
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA222720207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease