MEDICARE: MRS. NANCY A POWELL MD

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
1	207Q00000X	Family Medicine Physician	0101044021	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080134480	OTHER		RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1386639714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY A POWELL MD

Provider Business Mailing Address
First Line	:	1791 CAMBRIDGE DR.
Second Line	:	SUITE 203
City	:	RICHMOND
State	:	VA
Zip	:	23238
Country	:	US
Telephone Number	:	804-658-0435
Fax Number	:	804-562-8584

Provider Business Practice Location Address
First Line	:	1719 CAMBRIDGE DR.
Second Line	:	SUITE 203
City	:	RICHMOND
State	:	VA
Zip	:	23238
Country	:	US
Telephone Number	:	804-658-0435
Fax Number	:	804-562-8584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	10/15/2010

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