Healthcare Provider Details

I. General information

NPI: 1598079956
Provider Name (Legal Business Name): TODD M JARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

IV. Provider business mailing address

64 BLEECKER ST # 151
NEW YORK NY
10012-2410
US

V. Phone/Fax

Practice location:
  • Phone: 302-313-1584
  • Fax:
Mailing address:
  • Phone: 302-313-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60165757
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: