Provider Demographics
NPI:1619169042
Name:POWELL, JOHN DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:875 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5004
Mailing Address - Country:US
Mailing Address - Phone:717-652-1107
Mailing Address - Fax:717-652-1142
Practice Address - Street 1:875 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5004
Practice Address - Country:US
Practice Address - Phone:717-652-1107
Practice Address - Fax:717-652-1142
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293364208600000X, 208600000X
PAMD447851208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery