Healthcare Provider Details

I. General information

NPI: 1356338560
Provider Name (Legal Business Name): STEVEN L POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WASHINGTON ST STE 430
NORWICH CT
06360-2700
US

IV. Provider business mailing address

330 WASHINGTON ST STE 430
NORWICH CT
06360-2700
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-1862
  • Fax: 860-886-2046
Mailing address:
  • Phone: 860-886-1862
  • Fax: 860-886-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number029502
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: