Provider Demographics
NPI:1033300884
Name:POWELL, CHRISTOPHER ALLEN (NAVY SFIDC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:POWELL
Suffix:
Gender:M
Credentials:NAVY SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 PARK CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788-1501
Mailing Address - Country:US
Mailing Address - Phone:301-271-1460
Mailing Address - Fax:301-271-1464
Practice Address - Street 1:14900 PARK CENTRAL RD
Practice Address - Street 2:
Practice Address - City:THURMONT
Practice Address - State:MD
Practice Address - Zip Code:21788-1501
Practice Address - Country:US
Practice Address - Phone:301-271-1460
Practice Address - Fax:301-271-1464
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman