Provider Demographics
NPI:1730204249
Name:MARK W. POWELL, M.D. AND SHEILA M. BORICK, M.D.
Entity type:Organization
Organization Name:MARK W. POWELL, M.D. AND SHEILA M. BORICK, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-863-7888
Mailing Address - Street 1:131 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-1425
Mailing Address - Country:US
Mailing Address - Phone:610-863-7888
Mailing Address - Fax:610-863-1081
Practice Address - Street 1:131 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1425
Practice Address - Country:US
Practice Address - Phone:610-863-7888
Practice Address - Fax:610-863-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035977E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02283700OtherCAPITAL BLUE CROSS