Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 35043250 | OH |
NPI | 1679569412 |
---|---|
Provider Name | Dwight Alden Powell |
First Address | Columbus, OH 43205-2654 |
Second Address | Columbus, OH 43205-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 14/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010543000 | (05) | WV |
0398341 | (05) | OH |
64789118 | (05) | KY |
C02943 | (02) | |
PO0568572 | MEDICARE OHIO (01) | OH |