Provider Demographics
NPI:1528024288
Name:HOWELL, JODIE (MD)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:HOWELL
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 1:5861 MASON-DIXON HIGHWAY
Mailing Address - Street 2:BOX 72
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521
Mailing Address - Country:US
Mailing Address - Phone:304-432-8211
Mailing Address - Fax:304-432-8213
Practice Address - Street 1:5861 MASON-DIXON HIGHWAY
Practice Address - Street 2:BOX 72
Practice Address - City:BLACKSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26521
Practice Address - Country:US
Practice Address - Phone:304-432-8211
Practice Address - Fax:304-432-8213
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004757Medicaid
WVP00401095OtherRR MEDICARE
WV3810004757Medicaid
I49032Medicare UPIN