Provider Demographics
NPI:1184850521
Name:POWELL, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:POWELL
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 1:3508 TYSON RD.
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQ
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:610-359-0714
Mailing Address - Fax:
Practice Address - Street 1:3508 TYSON RD.
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQ
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:610-359-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD005572E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice