MEDICARE: DR. ROBERT CHARLES 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	2084P0800X	Psychiatry Physician	64435	CT
2	2084P0800X	Psychiatry Physician	125768-1	NY

General Provider Information

NPI Number	:	1740263862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES POWELL MD

Provider Business Mailing Address
First Line	:	14 JENNIFER RD
Second Line	:
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-2608
Country	:	US
Telephone Number	:	847-819-2866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 WASHINGTON BLVD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2419
Country	:	US
Telephone Number	:	203-388-1600
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	01/15/2025

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