Provider Demographics
NPI:1861590127
Name:MESHEL, JACK CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:CHARLES
Last Name:MESHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WESTWOOD MEDICAL PARK
Mailing Address - Street 2:PO BOX 969
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2000
Mailing Address - Country:US
Mailing Address - Phone:276-326-1995
Mailing Address - Fax:276-326-1996
Practice Address - Street 1:10 WESTWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2000
Practice Address - Country:US
Practice Address - Phone:276-326-1995
Practice Address - Fax:276-326-1996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20780207RC0000X
VA0101232141207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019297Medicaid
VA010100224Medicaid
AM4238261OtherDEA
AM4238261OtherDEA
WV3810019297Medicaid
WVB93614Medicare UPIN