Provider Demographics
NPI:1811191679
Name:POWELL, BRADFORD COLE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:COLE
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5078 GENETIC MEDICINE BLDG
Mailing Address - Street 2:CAMPUS BOX 7264
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7264
Mailing Address - Country:US
Mailing Address - Phone:919-962-4916
Mailing Address - Fax:919-843-0291
Practice Address - Street 1:5078 GENETIC MEDICINE BLDG
Practice Address - Street 2:CAMPUS BOX 7264
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7264
Practice Address - Country:US
Practice Address - Phone:919-962-4916
Practice Address - Fax:919-843-0291
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01999207SG0201X
PAMD440084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics