Provider Demographics
NPI:1245296540
Name:POWELL, ERIK SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:SCOTT
Last Name:POWELL
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:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:300 CHAMBER DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1734
Practice Address - Country:US
Practice Address - Phone:513-475-8050
Practice Address - Fax:513-248-1809
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29968207Q00000X
OH35057336P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740818Medicaid
IN200060760Medicaid
KY64951288Medicaid
E97616Medicare UPIN
IN200060760Medicaid