Provider Demographics
NPI:1356338560
Name:POWELL, STEVEN L (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
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 1:330 WASHINGTON ST
Mailing Address - Street 2:STE 430
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-886-1862
Mailing Address - Fax:860-886-2046
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:STE 430
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-1862
Practice Address - Fax:860-886-2046
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029502207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT029502OtherUNITED HEALTHCARE
0464894OtherCIGNA HEALTHCARE
NH202374Medicaid
29925OtherOXFORD HEALTH PLAN
RI0000172Medicaid
030970OtherHEALTH NET
132830OtherPREFERRED ONE HEALTHCARE
CT010029502CT03OtherBLUE SHIELD
329502OtherCONNECTICARE
NLP046OtherOXFORD HEALTH PLAN
3341765OtherAETNA US HEALTHCARE MASTE
CT001295022Medicaid
29151OtherCONNECTICARE
NY85911Medicaid
NY01809681Medicaid
RI212874Medicaid
RI212874Medicaid
CT029502OtherUNITED HEALTHCARE
329502OtherCONNECTICARE
NY85911Medicaid