Healthcare Provider Details

I. General information

NPI: 1427027838
Provider Name (Legal Business Name): KERRY ALEXANDER POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE CRMH DEPARTMENT OF EMERGENCY MEDICINE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

362 PRESWICK WAY
SEVERNA PARK MD
21146-1515
US

V. Phone/Fax

Practice location:
  • Phone: 540-853-0824
  • Fax:
Mailing address:
  • Phone: 410-544-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101226904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: