Provider Demographics
NPI:1134221005
Name:MIRTH-JACOBELLI, BARBARA (DO)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:MIRTH-JACOBELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1441
Mailing Address - Country:US
Mailing Address - Phone:215-493-0133
Mailing Address - Fax:
Practice Address - Street 1:1382 NEWTOWN LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-2401
Practice Address - Country:US
Practice Address - Phone:215-968-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005122L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA482847JH9Medicare PIN
PAB42226Medicare UPIN