Provider Demographics
NPI:1972690949
Name:POWELL, DOROTHY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:J
Last Name:POWELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20757-0716
Mailing Address - Country:US
Mailing Address - Phone:301-505-0500
Mailing Address - Fax:301-505-0865
Practice Address - Street 1:4467 OLD BRANCH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1854
Practice Address - Country:US
Practice Address - Phone:301-505-0500
Practice Address - Fax:301-505-0865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000983213ES0131X
DCPO453213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD428264OtherMEDICARE PTAN
MDT31216Medicare UPIN