Provider Demographics
NPI:1215005699
Name:POWELL, ANGELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
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 1:79 HAMMOND LN STE 12
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2008
Mailing Address - Country:US
Mailing Address - Phone:518-566-7930
Mailing Address - Fax:518-566-7932
Practice Address - Street 1:79 HAMMOND LN STE 12
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2008
Practice Address - Country:US
Practice Address - Phone:518-566-7930
Practice Address - Fax:518-566-7932
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428037207Y00000X
NY297640-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05932430Medicaid