MEDICARE: JAMES R JEWELL MD

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	207R00000X	Internal Medicine Physician	162867	NY
2	207R00000X	Internal Medicine Physician	250874	MA

General Provider Information

NPI Number	:	1427041854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R JEWELL MD

Provider Business Mailing Address
First Line	:	1200 CENTRE ST
Second Line	:	DEPARTMENT OF MEDICINE
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1000
Country	:	US
Telephone Number	:	617-363-8293
Fax Number	:	617-363-8929

Provider Business Practice Location Address
First Line	:	421 N MAIN ST DEPT OF
Second Line	:
City	:	LEEDS
State	:	MA
Zip	:	01053-9700
Country	:	US
Telephone Number	:	413-584-4040
Fax Number	:	413-582-3074

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	09/26/2023

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