Maryland Board of Physicians Practitioner Profile System
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This data was extracted on 12/13/2017
Collen, Jacob Fredrick
License and Education
License No.: D79963 
Special License Category  
Accepts Medicaid: No 
Maintains Malpractice Ins: data not available 
Graduated: 2002 
License Status: Active 
Date License Issued: 06/19/2015 
License Expiration: 09/30/2018 
  Primary Practice Setting
Walter Reed National Military Medical Ce 
8901 Wisconsin Ave 
 
Bethesda 
MD  20889
  Public Address
Walter Reed NMMC 
8901 Rockville Pike 
 
Bethesda 
MD  20889
        Graduated from: UNIFORMED SERVICES UNIV OF THE HLTH SCI
Postgraduate Training Program Concentration
Walter Reed Army Medical Center, Washington, DC Internal Medicine
Brooke Army Medical Center, Ft Sam Houston, TX General Practice
Walter Reed National Military Medical Center, Bethesda, MD Pulmonary Diseases/Critical Care
Walter Reed National Military Medical Center, Bethesda, MD Medicine, Internal, Sleep Medicine
Specialty Board Certification
by ABMS/AOA - as reported by licensee
Internal Medicine
Internal Medicine, Critical Care Medicine
Internal Medicine, Pulmonary Disease
Internal Medicine, Sleep Medicine
Self-Designated Practice Area
Licensee has not reported area of practice information for the profile site.
Maryland Hospital Privilege Information- as reported by licensee
Licensee has not reported privilege information for the profile site pursuant to HO 14-413.
Medical Licenses Held in Other States- as reported by licensee
Licensee has not reported this information for the profile site.
Active Supervisee - Delegation Agreement For Core Duties- as reported by licensee
 
 
Known Disciplinary Actions by any state medical board (within the past 10 years)
Summary: No actions reported during the last ten year period.
Download all Maryland Disciplinary Actions
None
Pending Charges
None
Malpractice   (Information to be taken into consideration when reviewing a Licensee's profile)
      Malpractice Judgments and Arbitration Awards (within the past 10 years)
None Reported

      Malpractice Settlements
      (If there are 3 or more settlements of $150,000 or greater within the past 5 years)
None Reported
Convictions for any crime involving moral turpitude
None reported by the courts

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