Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1251 | MA |
N | 222Z00000X | Podiatrist | 1251 | MA |
N | 213EP1101X | Primary Podiatric Medicine | 1251 | MA |
N | 111NR0200X | Radiology | 1251 | MA |
N | 213ER0200X | Radiology | 1251 | MA |
Y | 213ES0103X | Foot & Ankle Surgery | 1251 | MA |
NPI | 1730490244 |
---|---|
Provider Name | Dr. Kelly Ann Powers |
First Address | Stamford, CT 06902-7082 |
Second Address | Greenwich, CT 06830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 28/01/2015 |