Provider Demographics
NPI:1144224536
Name:POWERS, COLLEEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ANN
Last Name:POWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SCRABBLETOWN RD STE A
Mailing Address - Street 2:
Mailing Address - City:N KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3638
Mailing Address - Country:US
Mailing Address - Phone:401-295-7400
Mailing Address - Fax:401-295-7825
Practice Address - Street 1:420 SCRABBLETOWN RD
Practice Address - Street 2:STE A
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3638
Practice Address - Country:US
Practice Address - Phone:401-295-7400
Practice Address - Fax:401-295-7825
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
RI9449208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002693Medicaid
RI007057347OtherMEDICARE
RI9002693Medicaid