Provider Demographics
NPI:1962475202
Name:JACOBSON, ABRIN A (PA)
Entity type:Individual
Prefix:
First Name:ABRIN
Middle Name:A
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 CROOKED OAK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-569-3279
Mailing Address - Fax:717-569-2187
Practice Address - Street 1:1650 CROOKED OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4278
Practice Address - Country:US
Practice Address - Phone:717-569-3279
Practice Address - Fax:717-569-2187
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074973DW4Medicare ID - Type Unspecified
PAP51794Medicare UPIN