Healthcare Provider Details

I. General information

NPI: 1700347606
Provider Name (Legal Business Name): JARED NOWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON RD STE 102
WESTMINSTER MD
21157-6664
US

IV. Provider business mailing address

844 WASHINGTON RD STE 102
WESTMINSTER MD
21157-6664
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-0088
  • Fax:
Mailing address:
  • Phone: 410-871-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number279864
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.257839
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberD0106514
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: