Provider Demographics
NPI:1275528309
Name:BELL, JASON M (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:BELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CENTURIAN DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2137
Mailing Address - Country:US
Mailing Address - Phone:302-994-5275
Mailing Address - Fax:302-994-1794
Practice Address - Street 1:1 CENTURIAN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-994-5275
Practice Address - Fax:302-994-1794
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEEI0000152213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00B095F29Medicare ID - Type Unspecified
U87164Medicare UPIN
DEG02345A01Medicare PIN