Provider Demographics
NPI:1487877593
Name:JULIAN JAKOBOVITS MD LLC
Entity type:Organization
Organization Name:JULIAN JAKOBOVITS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOBOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-580-0900
Mailing Address - Street 1:2835 SMITH AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:410-580-0900
Mailing Address - Fax:410-580-0773
Practice Address - Street 1:2835 SMITH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-580-0900
Practice Address - Fax:410-580-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25039207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260331400Medicaid
MD260331400Medicaid
210M257FMedicare ID - Type Unspecified