Fadi Paul Jacob

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

055347519 Issued in GA

Practice address

600 North Wolfe Street
Baltimore, MD 21287-2109

Phone

(410) 955-5000

NPI assigned

Jan 8, 2016

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1306202122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 RUTLAND AVENUE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212052109",
            "telephone_number": "410-955-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NORTH WOLFE STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212872109",
            "telephone_number": "410-955-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "FADI",
        "middle_name": "PAUL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-08",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": "055347519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vandelle Dianne Jackson, PHARMD
• Vera Lorraine Jackson
• Waynyell Jackson, LCSW-C
• Jacksons Jubilee LLC
• Carla Jacob
• Priyanka Jacob
• Andrea Jacobs
• Ashley Jacobs
• Cosmo Gordon Jacobs, MD
• Dawn Anita Jacobs, PHARMD

• Student in an Organized Health Care Education/Training Program in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Student in an Organized Health Care Education/Training Program in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; 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.