Provider Demographics
NPI:1447239520
Name:JEWELL, NOEL B (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:B
Last Name:JEWELL
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 1:131 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-5402
Mailing Address - Country:US
Mailing Address - Phone:304-872-6503
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:804 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MAXWELTON
Practice Address - State:WV
Practice Address - Zip Code:24957-8066
Practice Address - Country:US
Practice Address - Phone:304-497-0500
Practice Address - Fax:304-497-0516
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235892207R00000X, 2084P0800X
WV227322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI15551Medicare UPIN
VA005395J05Medicare ID - Type Unspecified