Provider Demographics
NPI:1942316914
Name:POWELL, RICHARD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
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:SECTION OF VASCULAR SURGERY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8677
Mailing Address - Fax:603-650-4973
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:SECTION OF VASCULAR SURGERY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8677
Practice Address - Fax:603-650-4973
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101302086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE4592Medicaid
NH30010685Medicaid
NHRE459202Medicare PIN
NH30010685Medicaid