Jacobs, Mary Amanda

Jacobs, Mary Amanda is an individual health care provider with primary practice located at 200 Scenery Dr. , State College PA 16801-5602. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is her primary health care specialty. Jacobs, Mary Amanda can be contacted via phone (814) 231-4560.

Contact Information

Primary practice address
200 Scenery Dr. State College PA 16801-5602
Phone: (814) 231-4560
Fax: (814) 231-6246
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 46763 Minnesota
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X MD437386 Pennsylvania

Profile Details

NPI number 1811973894
LBN Legal business name Jacobs, Mary Amanda
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 21st, 2005
Last updated Aug 5th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811973894 NPPES
Iowa MEDICAID ENROLLED
Iowa MEDICAID 102337081
Iowa MEDICAID 699485700
Iowa Other P00333407
Iowa MEDICAID 35163500

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