Provider Demographics
NPI:1902878382
Name:JACOBS, JENNIFER H (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-361-3128
Mailing Address - Fax:703-361-3670
Practice Address - Street 1:8140 ASHTON AVE
Practice Address - Street 2:STE 120
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5698
Practice Address - Country:US
Practice Address - Phone:703-361-3128
Practice Address - Fax:703-361-3670
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057239207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA435992OtherANTHEM
VA221572OtherMAMSI
VA435993OtherANTHEM
VA006311059Medicaid
VA006311059Medicaid
VA180000926Medicare PIN