Provider Demographics
NPI:1467599464
Name:JARRELL, DANIEL LEE (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:JARRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1939
Practice Address - Fax:740-374-1693
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2047805Medicaid
WV9801990000Medicaid
OHP01055412OtherRAILROAD MEDICARE
WV9801990000Medicaid
OHH054140Medicare PIN