Provider Demographics
NPI:1740623909
Name:DR DOROTHY J POWELL PC
Entity type:Organization
Organization Name:DR DOROTHY J POWELL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-505-0500
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:240-244-4106
Practice Address - Street 1:4467 OLD BRANCH AVE STE 105
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00983213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD428264OtherMEDICARE PTAN
MDT31216Medicare UPIN