Provider Demographics
NPI:1730619610
Name:POWELL, JOHN PRESTON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PRESTON
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:APT 4
Mailing Address - Street 2:68 B STREET
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:01406
Mailing Address - Country:US
Mailing Address - Phone:207-272-5417
Mailing Address - Fax:
Practice Address - Street 1:68 B STREET APT 4
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-272-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036269-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty