Provider Demographics
NPI:1568481562
Name:POWELL FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:POWELL FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEE-POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-438-1030
Mailing Address - Street 1:6013 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2759
Mailing Address - Country:US
Mailing Address - Phone:215-438-1030
Mailing Address - Fax:215-438-4579
Practice Address - Street 1:6013 GREENE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2759
Practice Address - Country:US
Practice Address - Phone:215-438-1030
Practice Address - Fax:215-438-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA589268Medicare ID - Type Unspecified