Basic Information
| Provider Information | |||||||||
| NPI: | 1356491237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDS | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | MAGEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 BURLINGTON MALL RD. | ||||||||
| Address2: | ONCOLOGY DEPARTMENT, LAHEY CLINIC | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448301 | ||||||||
| FaxNumber: | 7817447553 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 BURLINGTON MALL RD. | ||||||||
| Address2: | LAHEY CLINIC | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167347080 | ||||||||
| FaxNumber: | 7817447553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A97655 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 252674 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 110093733A | 05 | MA | MEDICAID |