Provider Demographics
NPI:1285808113
Name:BELL, JENNIFER J (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:BELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CANDACE
Other - Last Name:JEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 HERBERT CT
Practice Address - Street 2:ECU PHYSICIANS PEDIATRIC ENDOCRINOLOGY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3736
Practice Address - Country:US
Practice Address - Phone:252-744-2516
Practice Address - Fax:252-744-2521
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4709208000000X, 2080P0205X
FLME1045682080P0205X
NC2016-007542080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19KMWOtherBCBS OF NC
NC1285808113Medicaid
NC19KMWOtherBCBS OF NC