Provider Demographics
NPI:1497734305
Name:POWERS, PATRICK LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEWIS
Last Name:POWERS
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:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-288-0055
Practice Address - Fax:804-288-2659
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054419207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00Y217A03OtherMEDICARE PTAN
VA1497734305Medicaid
VA00560923Medicaid
VA282170OtherMAMSI
VA00Y217A03OtherMEDICARE PTAN
VA124631OtherSOUTHERN HEALTH
VA29817OtherSENTERA
VA433173OtherANTHEM
VA282170OtherMAMSI