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NPI Code Detail

MEDICARE: MARITA POWELL DO

MEDICARE: MARITA POWELL DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician187655NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215989538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARITA POWELL DO
Provider Business Mailing Address
First Line : 58 LUSK ST
Second Line :
City : JOHNSON CITY
State : NY
Zip : 13790-2541
Country : US
Telephone Number : 607-763-6293
Fax Number : 607-763-6717
Provider Business Practice Location Address
First Line : 40 ARCH ST
Second Line :
City : JOHNSON CITY
State : NY
Zip : 13790-2102
Country : US
Telephone Number : 607-763-6075
Fax Number : 607-763-5234
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 08/05/2010

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Directions to “ MARITA POWELL DO” Practice Location

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