MEDICARE: MARIE B FEARON-JEWELL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0102201186	VA
2	207Q00000X	Family Medicine Physician	1749	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00466094	OTHER	WV	RAILROAD PTAN
2	001717979	OTHER	WV	BLUE CROSS BLUE SHIELD
3	345878	OTHER	VA	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134108210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE B FEARON-JEWELL DO

Provider Business Mailing Address
First Line	:	298 OAK CREST LN
Second Line	:
City	:	CALDWELL
State	:	WV
Zip	:	24925-9729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 HEALTH CENTER DRIVE
Second Line	:
City	:	UNION
State	:	WV
Zip	:	24983
Country	:	US
Telephone Number	:	304-772-3064
Fax Number	:	304-772-5671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	02/27/2013

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