Provider Demographics
NPI:1386639714
Name:POWELL, NANCY A (MD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
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 1:1791 CAMBRIDGE DR.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238
Mailing Address - Country:US
Mailing Address - Phone:804-658-0435
Mailing Address - Fax:804-562-8584
Practice Address - Street 1:1719 CAMBRIDGE DR.
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238
Practice Address - Country:US
Practice Address - Phone:804-658-0435
Practice Address - Fax:804-562-8584
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080134480OtherRR MEDICARE
VA010136725Medicaid
VA5638798Medicaid
VA5638798Medicaid
VA080006820Medicare ID - Type Unspecified
080134480OtherRR MEDICARE