Provider Demographics
NPI:1871675322
Name:POWDERLY, MARY KATHERINE (MD, FACOG, AAAAM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:POWDERLY
Suffix:
Gender:F
Credentials:MD, FACOG, AAAAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HUNTERS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7706
Mailing Address - Country:US
Mailing Address - Phone:732-873-1843
Mailing Address - Fax:732-873-8977
Practice Address - Street 1:32 WORLDS FAIR DR STE 201
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1388
Practice Address - Country:US
Practice Address - Phone:732-356-1266
Practice Address - Fax:732-356-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04685500208D00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223621722OtherFEDERAL TIN
NJF09773Medicare UPIN