Provider Demographics
NPI:1295778348
Name:POWELL, HENRY C (MD, DSC, FRCPATH)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:C
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD, DSC, FRCPATH
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Mailing Address - Street 1:200 WEST ARBOR DRIVE, MC 8320
Mailing Address - Street 2:UCSD DEPARMENT OF PATHOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-543-5966
Mailing Address - Fax:619-543-3730
Practice Address - Street 1:200 WEST ARBOR DRIVE, MC 8320
Practice Address - Street 2:UCSD DEPARMENT OF PATHOLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-543-5966
Practice Address - Fax:619-543-3730
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25597207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A255970Medicaid
CA00A255970Medicaid
CAWA25597AMedicare PIN