Ms. Dianne Roseberry Jacobs
Ms. Dianne R Jacobs · Physician Assistant (Medical)

Address: 1699 Leadenhall Street, Spring Gardens Medical Dispensary, Baltimore, MD 21230
Phone: 4102914800

Ms. Dianne Roseberry Jacobs (NPI# 1588838585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1588838585
Entity Type Individual
Full Name Ms. Dianne Roseberry Jacobs
Other Name Ms. Dianne R Jacobs
Credential PAC
Gender Female
Practice Address 1699 Leadenhall Street
Spring Gardens Medical Dispensary
Baltimore
MD 21230
Practice Telephone 4102914800
Practice Fax Number 4102914511
Mailing Address 1699 Leadenhall Street
Spring Gardens Medical Dispensary
Baltimore
MD 21230
Mailing Telephone 4102914800
Mailing Fax Number 4102914511
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2008-04-22
Last Update Date 2008-04-22

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 363AM0700X Physician Assistant · Medical Physician Assistants & Advanced Practice Nursing Providers C0000147 MD

Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

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Office Location

Street Address 1699 LEADENHALL STREET
SPRING GARDENS MEDICAL DISPENSARY
City BALTIMORE
State MD
Zip Code 21230

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Competitor

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City BALTIMORE
Zip Code 21230

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.