Provider Demographics
NPI:1992738488
Name:POWELSON, STEPHEN W (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:POWELSON
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 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-288-3123
Mailing Address - Fax:804-288-6591
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-288-3123
Practice Address - Fax:804-288-6591
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060020414OtherRAILROAD MEDICARE
VA517396OtherUNITED HEALTHCARE
VA530915OtherAETNA
VAC06695OtherGROUP PTAN
VA006023649Medicaid
VA0689605OtherCIGNA
VAC06695OtherGROUP PTAN
VA0689605OtherCIGNA