Provider Demographics
NPI:1588659650
Name:POWELSON, MYRON III (MD)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:POWELSON
Suffix:III
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 1:945 BETHESDA DRIVE
Mailing Address - Street 2:200B
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1406
Mailing Address - Country:US
Mailing Address - Phone:740-455-4937
Mailing Address - Fax:740-455-4931
Practice Address - Street 1:2951 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1406
Practice Address - Country:US
Practice Address - Phone:513-672-3309
Practice Address - Fax:513-672-3323
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045748207L00000X
OH35.045748207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050056064OtherRAILROAD MEDICARE
OH0527255Medicaid
050056064OtherRAILROAD MEDICARE