Active NPI
David Reid Jacoby, M.D., PH.D.
- Neurology Physician
- Charlestown, MA
National Provider Identifier
1902992449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 151320
- Practice address
- 55 Tremont Street
Charlestown, MA 02129-3148 - Phone
- (617) 242-5371
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 151320 | MA | Primary |
Addresses
Primary practice location
55 Tremont Street
Charlestown, MA 02129-3148
Mailing address
55 Tremont Street
Charlestown, MA 02129-3148
Phone (617) 242-5371
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 151320 | MA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902992449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 TREMONT STREET",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021293148",
"telephone_number": "617-242-5371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 TREMONT STREET",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021293148",
"telephone_number": "617-242-5371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBY",
"first_name": "DAVID",
"middle_name": "REID",
"name_prefix": "Dr.",
"credential": "M.D., PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MA",
"license": "151320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlestown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.