Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 236569 | MA |
Y | 2080A0000X | Adolescent Medicine | 236569 | MA |
NPI | 1124173000 |
---|---|
Provider Name | Anne C Powell |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 02/11/2020 |