Provider Demographics
NPI:1396740114
Name:POWELL, THOMAS WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:131 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3915
Mailing Address - Country:US
Mailing Address - Phone:919-934-5441
Mailing Address - Fax:919-934-0152
Practice Address - Street 1:910 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4751
Practice Address - Country:US
Practice Address - Phone:919-989-7909
Practice Address - Fax:919-989-3147
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19387208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8968862Medicaid
NCC86045Medicare UPIN
NC8968862Medicaid