MARY AMANDA JACOBS (NPI# 1811973894) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811973894 |
| Entity Type | Individual |
| Full Name | MARY AMANDA JACOBS |
| Credential | M.D. |
| Practice Address |
200 Scenery Dr. State College PA 16801-5602 |
| Mailing Address |
100 N Academy Ave Danville PA 17822-4903 |
| Practice Telephone | 8142314560 |
| Practice Fax Number | 8142316246 |
| Mailing Telephone | 5702716144 |
| Mailing Fax Number | 5702716578 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-08-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 46763 | MN | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MD437386 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 699485700 | 05 | |
| IA | ENROLLED | 05 | |
| PA | 102337081 | 05 | |
| WI | 35163500 | 05 | |
| MN | RAILROAD MEDICARE | P00333407 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194173229 | Mary Katherine Jacobs | Speech-Language Pathologist | 6966 Milum Rd, Lead Hill, AR 72644-9000 | 2016-05-31 |
| 1093107112 | Mary Jacobs | Licensed Practical Nurse | 3810 Ne 14th St, Gainesville, FL 32609-2413 | 2015-02-26 |
| 1871772632 | Mary W. Jacobs | Social Worker | 31 White Oak Rd, Waban, MA 02468-1322 | 2007-10-29 |
| 1801880414 | Mary E Jacobs | Specialist/Technologist | 4201 S Washington St, Marion, IN 46953-4974 | 2005-09-09 |
| 1477002087 | Mary Jacobs | Social Worker | 85 W Burnside Ave, Bronx, NY 10453-4015 | 2016-09-23 |
| 1144680448 | Mary Jacobs | Social Worker | 2173 N Ridge Rd E, Suite E, Lorain, OH 44055-3400 | 2016-02-29 |
| 1841622826 | Mary Elizabeth Jacobs | Nurse Practitioner | 4221 Charlar Dr, Holt, MI 48842-6804 | 2013-08-01 |
| 1548575509 | Mary Alexandra Jacobs | Counselor | 902 S Myrtle Ave, Monrovia, CA 91016-3427 | 2010-08-15 |
| 1649491390 | Mary Kaye Jacobs | Marriage & Family Therapist | Family Care Center, 1425 Story Avenue, Louisville, KY 40206 | 2007-05-01 |
| 1275756397 | Mary Ann Jacobs | Social Worker | 721 W Maple St, Rawlins, WY 82301-5447 | 2007-04-10 |
| Street Address |
200 SCENERY DR. |
| City | STATE COLLEGE |
| State | PA |
| Zip Code | 16801-5602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023215670 | Keriann Nickola Gray | Internal Medicine | 200 Scenery Dr., State College, PA 16801-5602 | 2007-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851880975 | Creative Reflections Counseling, LLC | Counselor | 315 S Allen St Ste 124b, State College, PA 16801 | 2018-05-03 |
| 1679097901 | Michelle L Grove | Home Health Aide | 2100 E College Ave Ste B, State College, PA 16801 | 2017-07-28 |
| 1740702034 | Matthew Ishler | Counselor | 315 S. Allen Street Ste 326, State College, PA 16801 | 2017-07-09 |
| 1699206300 | Emily Lauer | Specialist/Technologist | 102a Multisport Indoor Facility, State College, PA 16801 | 2017-03-23 |
| 1740721075 | Luk Devorski | Student in an Organized Health Care Education/Training Program | Rec Hall University Park, Penn State University, State College, PA 16801 | 2017-03-20 |
| 1013465764 | Pennsylvania Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 201 West Beaver Avenue, State College, PA 16801 | 2016-09-12 |
| 1740685858 | Mallory L. Miller | Physician Assistant | 100 Radnor Rd Ste 101, State College, PA 16801 | 2014-10-31 |
| 1386053981 | Christopher Hippenmeyer | Specialist/Technologist | 102a East Area Locker Building, Pennsylvania State University, University Park, PA 16801 | 2014-08-07 |
| 1982022059 | Christy Sharer | Counselor | 301 S Allen St Ste 106, State College, PA 16801 | 2014-04-04 |
| 1912250523 | Eva M Letwin | Counselor | 2011 Cato Ave Ste 201, State College, PA 16801 | 2012-10-19 |
| Find all providers in zip 16801 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538600853 | Dermone Dermatology Associates of The Keystone State, P.c | Dermatology | 200 Barr Harbor Drive, Four Tower Bridge, Suite 200, West Conshohocken, PA 19428 | 2017-03-20 |
| 1962802249 | Carlisle Dermatology Group | Dermatology | 19 Sprint Drive, Suite 1, Carlisle, PA 17015-7002 | 2014-08-24 |
| 1922418516 | Veronica Rutt | Dermatology | 1665 Valley Center Pkwy Ste 120, Bethlehem, PA 18017-2353 | 2014-05-05 |
| 1003109059 | Amanda Joy Tschetter | Dermatology | 575 Coal Valley Rd Ste 360, Clairton, PA 15025-3739 | 2011-05-24 |
| 1871893529 | Accurate Dermatology Pa, LLC | Dermatology | 2805 Fringe Lane, Easton, PA 18040 | 2010-10-28 |
| 1134393028 | Paul Xavier Benedetto | Dermatology | 2221 Garrett Rd, Drexel Hill, PA 19026-1101 | 2008-04-22 |
| 1558549733 | Keystone Dermatology & Center for Skin Surgery, LLC | Dermatology | 2525 9th Ave Ste 2, Altoona, PA 16602-2014 | 2008-02-10 |
| 1710174511 | The Skin and Cancer Center | Dermatology | 18 Millridge Dr, Aston, PA 19014-1063 | 2007-09-26 |
| 1871785683 | Kevin Crouse, Md PC | Dermatology | 250 Pierce St Ste 217, Kingston, PA 18704-5149 | 2007-08-15 |
| 1326240557 | Marc Kevin Rubenzik | Dermatology | 233 S 10th St, Suite 450, Philadelphia, PA 19107-5541 | 2007-06-01 |
| Find all providers with the same taxonomy | ||||
| City | STATE COLLEGE |
| Zip Code | 16801 |
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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.