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General NPI Number Information
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NPI Number | 1891833570
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Entity Type | Organization
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Legal Business Name | BRIAN POWDERLY MD
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 2675 36TH ST
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City | PARKERSBURG
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State | WV
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Zip | 26104-8024
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Country | US
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Telephone | 304-422-8112
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Fax | 304-422-3924
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Provider Business Mailing Address
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Address Line | 301 SAINT ANDREWS BLVD
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City | BELPRE
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State | OH
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Zip | 45714-9327
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Country | US
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Telephone | 304-422-8112
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Fax | 304-422-3924
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN POWDERLY
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Credential | MD
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Telephone | 304-422-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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