Provider Demographics
NPI:1598737629
Name:POWELL, GREGORY HARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HARRY
Last Name:POWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-695-6455
Mailing Address - Fax:301-695-6456
Practice Address - Street 1:97 THOMAS JOHNSON DR
Practice Address - Street 2:STE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-695-6455
Practice Address - Fax:301-695-6456
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P10908Medicare UPIN
902LMedicare ID - Type Unspecified