Provider Demographics
NPI:1538140736
Name:JARRELL, EUGENIA M (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:M
Last Name:JARRELL
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 1:1288 B STREET P.O. BOX 327
Mailing Address - Street 2:
Mailing Address - City:CEREDO
Mailing Address - State:WV
Mailing Address - Zip Code:25507-0327
Mailing Address - Country:US
Mailing Address - Phone:304-453-3334
Mailing Address - Fax:304-453-2608
Practice Address - Street 1:1288 B STREET
Practice Address - Street 2:
Practice Address - City:CEREDO
Practice Address - State:WV
Practice Address - Zip Code:25507-0327
Practice Address - Country:US
Practice Address - Phone:304-453-3334
Practice Address - Fax:304-453-2608
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001713633OtherBLUE CROSS BLUE SHIELD
WV2005201000Medicaid
001713633OtherBLUE CROSS BLUE SHIELD
WVH86433Medicare UPIN