Provider Demographics
NPI:1952386989
Name:POWERS, WILLIAM THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:POWERS
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 1:108 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1600
Mailing Address - Country:US
Mailing Address - Phone:276-783-6879
Mailing Address - Fax:
Practice Address - Street 1:1532 SLATE CREEK RD
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6975
Practice Address - Country:US
Practice Address - Phone:276-935-2080
Practice Address - Fax:276-935-2082
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-00846207R00000X
VA0101033664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110243993OtherRAILROAD MEDICARE
VA167059OtherBLACK LUNG
KY64103146Medicaid
VA005877083Medicaid
VA110211269OtherRAILROAD MEDICARE
VA005845009Medicaid
VA285168OtherVA BC/BS (ANTHEM)
WV3810003039Medicaid
VA010141729Medicaid
VA175190OtherANTHEM
VA1952386989Medicaid
VA22307403OtherWORKMEN'S COMP
VA460860OtherANTHEM
VA010141729Medicaid
VA110243993OtherRAILROAD MEDICARE
VA110211269OtherRAILROAD MEDICARE
VAB05797Medicare UPIN
VAVV6969AMedicare PIN