# BRIAN POWDERLY MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891833570
- **Authorized official:** BRIAN POWDERLY MD (OWNER)
- **Authorized official phone:** (304) 422-8112

## Contact information

- **Practice address:** 2675 36TH ST, PARKERSBURG, WV 26104-8024
- **Practice address phone:** (304) 422-8112
- **Practice address fax:** (304) 422-3924
- **Mailing address:** 301 SAINT ANDREWS BLVD, BELPRE, OH 45714-9327
- **Mailing address phone:** (304) 422-8112
- **Mailing address fax:** (304) 422-3924

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 11/01/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2125417 | — | OH |
| 05 | — | 3810006475 | — | WV |