Provider Demographics
NPI:1043478241
Name:POWELL, AMANDA G (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:G
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:LAHEY HOSPITAL & MEDICAL CENTER
Mailing Address - Street 2:50 MALL ROAD., SUITE G03
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4529
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:781-744-5636
Practice Address - Street 1:LAHEY HOSPITAL & MEDICAL CTR
Practice Address - Street 2:50 MALL RD. G03
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:855-934-4488
Practice Address - Fax:781-744-5636
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2018-01-26
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Provider Licenses
StateLicense IDTaxonomies
MA244277207R00000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086900AMedicaid
MA110086900AMedicaid