Healthcare Provider Details

I. General information

NPI: 1215005699
Provider Name (Legal Business Name): ANGELA M POWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HAMMOND LN STE 12
PLATTSBURGH NY
12901-2008
US

IV. Provider business mailing address

79 HAMMOND LN STE 12
PLATTSBURGH NY
12901-2008
US

V. Phone/Fax

Practice location:
  • Phone: 518-566-7930
  • Fax: 518-566-7932
Mailing address:
  • Phone: 518-566-7930
  • Fax: 518-566-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD428037
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number297640-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: