Provider Demographics
NPI:1790808517
Name:POWELL, KENTON EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENTON
Middle Name:EUGENE
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC - DEPARTMENT OF MEDICINE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9500
Mailing Address - Fax:
Practice Address - Street 1:204 DARTMOUTH COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:LYME
Practice Address - State:NH
Practice Address - Zip Code:03768-3205
Practice Address - Country:US
Practice Address - Phone:603-650-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14566207R00000X
VT042-0012689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209653Medicaid
NH3077484Medicaid
VT1017771Medicaid
NH001767802Medicare PIN
VT1017771Medicaid