Provider Demographics
NPI:1447218771
Name:POWELL, WENDY SOYINI (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SOYINI
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143
Mailing Address - Country:US
Mailing Address - Phone:215-747-6661
Mailing Address - Fax:215-471-1418
Practice Address - Street 1:5346 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143
Practice Address - Country:US
Practice Address - Phone:215-747-6661
Practice Address - Fax:215-471-1418
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035036E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010292640019Medicaid
D71651Medicare UPIN
467474Medicare ID - Type Unspecified