Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101019333 | VA |
NPI | 1003877416 |
---|---|
Provider Name | Raleigh C. Powell |
First Address | Glen Allen, VA 23060-9263 |
Second Address | Richmond, VA 23221-2718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5631157 | (05) | VA |
B08297 | (02) | VA |