Melissa Dale Jacobson

Individual provider Active NPI Other Specialist/Technologist · Shepherdstown, WV

NPI 1114743200 · NPPES record last updated Nov 23, 2024

Key facts

NPI
1114743200
Entity type
Individual (NPI type 1)
Primary specialty
Other Specialist/Technologist 246Z00000X
Practice address
75 Sybil CT
Shepherdstown, WV 25443-4669
Phone
(443) 960-0731
NPI assigned
Nov 23, 2024
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Other Specialist/Technologist 246Z00000X Yes

Addresses

Primary practice location

75 Sybil CT
Shepherdstown, WV 25443-4669

Mailing address

75 Sybil CT
Shepherdstown, WV 25443-4669
Phone (443) 960-0731

Other providers in Shepherdstown, WV

All providers in Shepherdstown, WV · Other Specialist/Technologist in West Virginia

Sources for this page

Verify at the official NPI Registry.