Provider Demographics
NPI:1528056561
Name:POWSNER, SETH M (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:POWSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TEMPLE ST
Mailing Address - Street 2:SUITE 6-C
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2715
Mailing Address - Country:US
Mailing Address - Phone:203-785-4085
Mailing Address - Fax:203-737-1597
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:SUITE 6-C
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-4085
Practice Address - Fax:203-737-1597
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0267072084P0800X, 2084P0805X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001267071Medicaid
CT001267071Medicaid
CT260000989Medicare ID - Type Unspecified