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Individual

JOHN DWYER POWDERLY II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
9801 KINCEY AVE, SUITE 145, HUNTERSVILLE, NC 28078-3110
(704) 947-6599
(704) 947-6597
Mailing address
PO BOX 3547, HUNTERSVILLE, NC 28070-3547

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200000939
NC
207RH0003X
Hematology & Oncology Physician
Primary
200000939
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12618
BCBS INDIVIDUAL NUMBER
NC
01
203016908
TAX ID
NC
01
4859724
CIGNA
NC
01
7413187
AETNA PIN
NC
05
8912618
NC
01
E2701
MEDCOST
NC
Enumeration date
07/21/2006
Last updated
07/10/2013
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