Provider Demographics
NPI:1083656771
Name:POWLIS, WILLIAM DAVENPORT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVENPORT
Last Name:POWLIS
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 1:101 COLUMBIAN ST
Mailing Address - Street 2:RADIATION ONCOLOGY
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1601
Mailing Address - Country:US
Mailing Address - Phone:781-624-4700
Mailing Address - Fax:781-624-4710
Practice Address - Street 1:101 COLUMBIAN ST
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1601
Practice Address - Country:US
Practice Address - Phone:781-624-4700
Practice Address - Fax:781-624-4710
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027906E2085R0001X
MA381222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0011060870002Medicaid
PA487351OtherHIGHMARK BCBS
PAF49342Medicare UPIN
PA487351TB4Medicare PIN