Provider Demographics
NPI:1639136955
Name:POWELL, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:POWELL
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 47
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848
Mailing Address - Country:US
Mailing Address - Phone:570-268-4713
Mailing Address - Fax:570-268-4716
Practice Address - Street 1:91 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-268-4713
Practice Address - Fax:570-268-4716
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037921E207R00000X, 207V00000X
NJ25MA05415300207V00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025499870002Medicaid
PA234112Y0LMedicare PIN
PA1025499870002Medicaid