Provider Demographics
NPI:1801836424
Name:MCDOWELL-JACOBS, LAUREN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:MCDOWELL-JACOBS
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 1:203 EARNHARDT DR STE B
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-8401
Mailing Address - Country:US
Mailing Address - Phone:252-482-5868
Mailing Address - Fax:252-482-7953
Practice Address - Street 1:203 EARNHARDT DR STE B
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-5283
Practice Address - Country:US
Practice Address - Phone:252-482-5868
Practice Address - Fax:252-482-7953
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087474208600000X
TNMD59668208600000X
NC2022-02614208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2647523Medicaid
OHMC4181192Medicare PIN
OH2647523Medicaid