Mark D. Jacobs, MD
Individual provider Active NPI Internal Medicine Physician · Needham, MA
NPI 1124013883 · NPPES record last updated Dec 19, 2016
Key facts
- NPI
- 1124013883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 242029 (MA)
- Practice address
- 100 2ND Ave
Needham, MA 02494-2809 - Phone
- (781) 726-4800
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Medical, Inc. | Past |
Accepting new patients | |
| Coastal Medical, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 242029 | MA | Yes |
Addresses
Primary practice location
100 2ND Ave
Needham, MA 02494-2809
Mailing address
100 2ND Ave
Needham, MA 02494-2809
Phone (781) 726-4800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NPI | Other | MA | 1124013883 |
| 9239986 | Other | MA | CIGNA |
| 9971374 | Other | MA | AETNA |
| 242029 | Other | MA | MEDICAL LICENSE |
| 404478 | Other | MA | TUFTS HEALTH PLAN |
| AA173484 | Other | MA | HPHC |
Other providers in Needham, MA
- Ashley Marie Ivey
- Renata Ivnitskaya
- Anthony Haig Jackson
- Deborah S. Jacobs
- Jerry Jacobs
- Renee M Jacobs
- Adam L Jacobson
- Lisa Jacobson
- Pragati Jaiswal
- Meagan Jameson
All providers in Needham, MA · Internal Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.