MEDICARE: DR. ANGELA M POWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MD428037	PA
2	207Y00000X	Otolaryngology Physician	297640-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215005699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M POWELL MD

Provider Business Mailing Address
First Line	:	79 HAMMOND LN STE 12
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2008
Country	:	US
Telephone Number	:	518-566-7930
Fax Number	:	518-566-7932

Provider Business Practice Location Address
First Line	:	79 HAMMOND LN STE 12
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2008
Country	:	US
Telephone Number	:	518-566-7930
Fax Number	:	518-566-7932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	12/10/2025

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