MEDICARE: DR. DOROTHY J POWELL DPM

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	213ES0131X	Foot Surgery Podiatrist	000983	MD
2	213ES0131X	Foot Surgery Podiatrist	PO453	DC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	428264	OTHER	MD	MEDICARE PTAN

General Provider Information

NPI Number	:	1972690949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY J POWELL DPM

Provider Business Mailing Address
First Line	:	PO BOX 716
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20757-0716
Country	:	US
Telephone Number	:	301-505-0500
Fax Number	:	301-505-0865

Provider Business Practice Location Address
First Line	:	4467 OLD BRANCH AVE
Second Line	:	SUITE 105
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1854
Country	:	US
Telephone Number	:	301-505-0500
Fax Number	:	301-505-0865

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	04/08/2013

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