MEDICARE: BRIAN DOUGLAS 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	207RC0001X	Clinical Cardiac Electrophysiology Physician	2005-00681	NC
2	207RC0000X	Cardiovascular Disease Physician	2005-00681	NC

General Provider Information

NPI Number	:	1952375909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DOUGLAS POWELL MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1237 HARDING PL
Second Line	:	STE 3100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-373-0212
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/16/2024

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