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General NPI Number Information
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NPI Number | 1013905363
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Entity Type | Individual
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Provider Name | SUZANNE M POWELL MD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 12A LEDGEBROOK DR
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1690
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Country | US
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Telephone | 860-423-2960
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Fax | 860-423-3719
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Provider Business Mailing Address
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Address Line | 320 POMFRET ST
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City | PUTNAM
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State | CT
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Zip | 06260-1836
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Country | US
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Telephone | 860-963-6390
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Fax | 860-963-6343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 042791
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License Number State | CT
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