Individual
MARITA POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
40 ARCH ST, JOHNSON CITY, NY 13790-2102
(607) 763-6075
(607) 763-5234
Mailing address
58 LUSK ST, JOHNSON CITY, NY 13790-2541
(607) 763-6293
(607) 763-6717
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
187655
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01493970
—
NY
Enumeration date
05/16/2006
Last updated
08/05/2010
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