Healthcare Provider Details

I. General information

NPI: 1790808517
Provider Name (Legal Business Name): KENTON EUGENE POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 DARTMOUTH COLLEGE HWY
LYME NH
03768-3205
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC - DEPARTMENT OF MEDICINE
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-1070
  • Fax:
Mailing address:
  • Phone: 603-653-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14566
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042-0012689
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: