Healthcare Provider Details

I. General information

NPI: 1922799238
Provider Name (Legal Business Name): MICHAEL POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SHIPPERS RD STE 203
VESTAL NY
13850-2082
US

IV. Provider business mailing address

3101 SHIPPERS RD STE 203
VESTAL NY
13850-2082
US

V. Phone/Fax

Practice location:
  • Phone: 607-786-4822
  • Fax:
Mailing address:
  • Phone: 607-786-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: