Dianne Roseberry Jacobs, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C0000147 Issued in MD

Practice address

1699 Leadenhall Street
Spring Gardens Medical Dispensary
Baltimore, MD 21230

Phone

(410) 291-4800

Fax

(410) 291-4511

NPI assigned

Apr 22, 2008

Last updated

Apr 22, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Dianne R Jacobs Other name

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": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1588838585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1699 LEADENHALL STREET",
            "address_2": "SPRING GARDENS MEDICAL DISPENSARY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21230",
            "telephone_number": "410-291-4800",
            "fax_number": "410-291-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1699 LEADENHALL STREET",
            "address_2": "SPRING GARDENS MEDICAL DISPENSARY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21230",
            "telephone_number": "410-291-4800",
            "fax_number": "410-291-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "DIANNE",
        "middle_name": "ROSEBERRY",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0000147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANNE",
            "last_name": "JACOBS",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "PAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Andrea Jacobs
• Ashley Jacobs
• Cosmo Gordon Jacobs, MD
• Dawn Anita Jacobs, PHARMD
• Deborah Gemora Jacobs, LCSW-C
• Erica S Jacobs, OT
• Jarrod Jacobs, LCSW-C
• Jessica Delores Jacobs, MD
• Jonathan Levi Jacobs, M.D.
• Karen Ellen Jacobs, D.D.S.

• Medical Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.