Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Glen Mirandilla Jacob, MD

Individual provider Internal Medicine Physician · NPI 1780757062

Dr. Glen Mirandilla Jacob, MD is an Internal Medicine in Largo, Maryland. Qualified in 1989, 37 years ago. Practices with Kaiser Foundation Health Plan of the Mid Atlantic States, Inc, a 1,934-clinician group, accepts Medicare assignment and offers telehealth. Licensed in District of Columbia, Maryland and New Mexico.

Years since qualifying
37
Licensed in
DC, MD, NM
In the registry since
2006
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

1221 Mercantile Ln
Largo, MD 20774-5374
Phone: (301) 618-5578
Fax: (301) 618-5673
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence D59633 (MD)
Internal Medicine Physician Taxonomy 207R00000X · Licence MD034269 (DC)
Internal Medicine Physician Taxonomy 207R00000X · Licence 9880 (NM)
Geriatric Medicine (Internal Medicine) Physician Taxonomy 207RG0300X · Licence D59633 (MD)

Record details

NPI number1780757062
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 16, 2006
Last updated in NPPESFebruary 23, 2022
Certification dateFebruary 23, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 1989 (37 years in practice)
Group practice Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc — 1934 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations6 on file with Medicare

Other providers in Largo