DR. MARY JACOB (NPI# 1124537667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124537667 |
| Entity Type | Individual |
| Full Name | DR. MARY JACOB |
| Credential | DMD |
| Practice Address |
334 Broadway Revere MA 02151-5016 |
| Mailing Address |
99 Florence Street Apt 102 Malden MA 02148 |
| Practice Telephone | 1781629624 |
| Mailing Telephone | 2035481113 |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2017-09-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN1857754 | MA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518425982 | Mary Deena Jacob | Nurse Practitioner | 2865 Mcdermott Rd #225, Plano, TX 75025 | 2019-03-05 |
| 1164774071 | Mary Jacob | Pharmacist | 16 S Waukegan Rd, Deerfield, IL 60015-5216 | 2012-10-03 |
| 1225321755 | Mary Sunny Jacob | Emergency Medicine | 2150 Pennsylvania Ave Nw, Washington, DC 20037-3201 | 2011-05-17 |
| 1194741041 | Mary Ann Jacob | Pediatrics | 2841 Debarr Rd, Suite 45, Anchorage, AK 99508-2932 | 2006-07-14 |
| 1396776571 | Mary R Jacob | Clinical Nurse Specialist | 1600 S Orlando Ave, Winter Park, FL 32789-5547 | 2006-07-05 |
| 1659348399 | Mary Anne Jacob | Obstetrics & Gynecology | 6545 France Avenue South, Suite 540, Edina, MN 55435 | 2006-03-01 |
| 1083612246 | Mary Casey Jacob | Psychologist | 263 Farmington Ave, Farmington, CT 06030-0001 | 2005-07-12 |
| Street Address |
334 BROADWAY |
| City | REVERE |
| State | MA |
| Zip Code | 02151-5016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427569870 | Divya Reddy Anugu | Dentist | 334 Broadway, Revere, MA 02151-5016 | 2017-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558853580 | Carla Richman | Behavioral Analyst | 29 Arnold Street, Revere, MA 02151 | 2018-06-05 |
| 1558859850 | Citizens Physical Therapy Inc | Clinic/Center | 221 Beach St, Revere, MA 02151 | 2018-04-23 |
| 1396254892 | Holness Home Care | Home Health | 959 Revere Beach Parkway, Revere, MA 02151 | 2017-09-27 |
| 1841709938 | Stefanie Finocchio-durham | Acupuncturist | 107 Pearl Ave, Apt 3, Revere, MA 02151 | 2017-09-21 |
| 1174064265 | Hope Noelle Crowe | Behavioral Analyst | 164 Winthrop Parkway, Revere, MA 02151 | 2017-03-09 |
| 1033660469 | Driss Bahraoui | Interpreter | 21 Thornton St #1, Revere, MA 02151 | 2016-10-20 |
| 1568910081 | Lindsey J. Ellermeyer | Student in an Organized Health Care Education/Training Program | Revere Community Counseling, 265 Beach Street, Revere, MA 02151 | 2016-09-13 |
| 1851743470 | Jacqueline Galvez | Counselor | 252 Proctor Ave # 3, Revere, MA 02151 | 2016-07-07 |
| 1518321090 | Kathleen Elizabeth Pellecchia | Health Educator | 454 Broadway Fl 3, Revere, MA 02151 | 2016-04-11 |
| 1780098814 | David A Gross | Internal Medicine | Mgh Revere, 385 Broadway, Revere, MA 02151 | 2014-06-17 |
| Find all providers in zip 02151 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316582877 | Kobie Charles Gordon | Dentist | 205 Revere Beach Pkwy Unit 630, Revere, MA 02151-5491 | 2019-11-08 |
| 1760718126 | Apple Dental Associates, LLC | Dentist | 651 Squire Rd, Revere, MA 02151-1866 | 2009-10-20 |
| 1326211293 | Bao Min Yee Dmd | Dentist | 49 Shirley Ave, Revere, MA 02151-5121 | 2008-04-10 |
| 1821261215 | Page Family Dental LLC | Dentist | 26 Central Avenue, Revere, MA 02151 | 2008-04-08 |
| 1891835609 | Dipietro Family Dental Care, Inc. | Dentist | 123 Revere St, Revere, MA 02151-4439 | 2007-02-08 |
| 1669525614 | Todd Belf-becker | Dentist | 34 Shirley Ave, Revere, MA 02151-5110 | 2007-01-20 |
| 1255433959 | John F Annese | Dentist | 106 Broadway, Revere, MA 02151 | 2006-09-02 |
| 1568577864 | John Benecchi | Dentist | 140 School St, Revere, MA 02151-3013 | 2006-08-20 |
| 1760411821 | Michael J Boschetti | Dentist | 1 Orr Sq, Revere, MA 02151-3200 | 2006-07-01 |
| 1861442394 | Ernest F Powers Jr. | Dentist | 276 Squire Rd, Revere, MA 02151 | 2006-05-12 |
| Find all providers in REVERE | ||||
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| 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.