Provider Demographics
NPI:1053616631
Name:FOX-MELLUL, JODI V (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:V
Last Name:FOX-MELLUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:V
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:34 COLSON LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1502
Mailing Address - Country:US
Mailing Address - Phone:856-223-0965
Mailing Address - Fax:856-223-1357
Practice Address - Street 1:34 COLSON LN
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1502
Practice Address - Country:US
Practice Address - Phone:856-223-0965
Practice Address - Fax:856-223-1357
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049417207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism