Provider Demographics
NPI:1104129170
Name:POWELL, JAMES JOSEPH IV (HIS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:POWELL
Suffix:IV
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5732
Mailing Address - Country:US
Mailing Address - Phone:610-433-2919
Mailing Address - Fax:
Practice Address - Street 1:1952 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5732
Practice Address - Country:US
Practice Address - Phone:610-433-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO3267332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment