Provider Demographics
NPI:1326067695
Name:HARRELL, JANE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:S
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 E 3RD ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3200
Mailing Address - Country:US
Mailing Address - Phone:704-806-0038
Mailing Address - Fax:704-770-3201
Practice Address - Street 1:1518 E 3RD ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3200
Practice Address - Country:US
Practice Address - Phone:704-806-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1349VOtherBCBS OF NC
SCN0003AMedicaid
NC891349VMedicaid
P00102236OtherMEDICARE RAILROAD
NC891349VMedicaid
I04267Medicare UPIN