Healthcare Provider Details

I. General information

NPI: 1508927021
Provider Name (Legal Business Name): DARRELL FRANKLIN POWLEDGE M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MCDOWELL AVE., NE SUITE B
ROANOKE VA
24016
US

IV. Provider business mailing address

512 MCDOWELL AVE., NE SUITE B
ROANOKE VA
24016
US

V. Phone/Fax

Practice location:
  • Phone: 540-362-9620
  • Fax: 540-362-9659
Mailing address:
  • Phone: 540-362-9620
  • Fax: 540-362-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101027148
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101027148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: