Individual
MARIE B FEARON-JEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
200 HEALTH CENTER DRIVE, UNION, WV 24983
(304) 772-3064
(304) 772-5671
Mailing address
298 OAK CREST LN, CALDWELL, WV 24925-9729
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102201186
VA
207Q00000X
Family Medicine Physician
Primary
1749
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001717979
BLUE CROSS BLUE SHIELD
WV
05
—
010038251
—
VA
01
—
345878
ANTHEM
VA
01
—
P00466094
RAILROAD PTAN
WV
Enumeration date
01/17/2006
Last updated
02/27/2013
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