1356338560 NPI number — STEVEN L POWELL MD

Table of content: STEVEN L POWELL MD (NPI 1356338560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356338560 NPI number — STEVEN L POWELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
STEVEN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356338560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 430
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-886-1862
Provider Business Mailing Address Fax Number:
860-886-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 430
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-886-1862
Provider Business Practice Location Address Fax Number:
860-886-2046
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  029502 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CT029502 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0464894 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202374 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29925 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000172 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030970 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132830 . This is a "PREFERRED ONE HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010029502CT03 . This is a "BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 329502 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NLP046 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3341765 . This is a "AETNA US HEALTHCARE MASTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001295022 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29151 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85911 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01809681 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212874 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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