Provider Demographics
NPI:1356310189
Name:JARRELL, TWIFFORD NOBLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TWIFFORD
Middle Name:NOBLE
Last Name:JARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3568
Mailing Address - Country:US
Mailing Address - Phone:302-678-4488
Mailing Address - Fax:302-678-4497
Practice Address - Street 1:725 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3568
Practice Address - Country:US
Practice Address - Phone:302-678-4488
Practice Address - Fax:302-678-4497
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000107601Medicaid
DEB66232Medicare UPIN
DE003167J68Medicare PIN