Provider Demographics
NPI:1649208885
Name:POWELL, ROBERT S (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:POWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1443
Mailing Address - Country:US
Mailing Address - Phone:508-238-7766
Mailing Address - Fax:508-230-5089
Practice Address - Street 1:66 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1443
Practice Address - Country:US
Practice Address - Phone:508-238-7766
Practice Address - Fax:508-230-5089
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA733532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11429OtherBC BS OF MASSACHUSETTS
MA478850OtherTUFTS HEALTH PLAN
MAJ11429OtherBC BS OF MASSACHUSETTS
MAE99415Medicare UPIN