Cosmo Gordon Jacobs, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D21328 Issued in MD

Practice address

4001 Liberty Heights Ave
Baltimore, MD 21207-8053

Phone

(410) 578-1100

NPI assigned

Nov 29, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286150400000",
    "number": "1093798639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 LIBERTY HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212077545",
            "telephone_number": "410-578-1100",
            "fax_number": "410-578-0596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 LIBERTY HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212078053",
            "telephone_number": "410-578-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "COSMO",
        "middle_name": "GORDON",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2010-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D21328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "791251000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla Jacob
• Fadi Paul Jacob
• Priyanka Jacob
• Andrea Jacobs
• Ashley Jacobs
• Dawn Anita Jacobs, PHARMD
• Deborah Gemora Jacobs, LCSW-C
• Dianne Roseberry Jacobs, PAC
• Erica S Jacobs, OT
• Jarrod Jacobs, LCSW-C

• Internal Medicine Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.