Healthcare Provider Details

I. General information

NPI: 1205968666
Provider Name (Legal Business Name): CAROLYN SMITH BURWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTHAMPTON AVENUE NORFOLK DEPT OF PUBLIC HEALTH
NORFOLK VA
23510
US

IV. Provider business mailing address

33266 EDGEHILL DRIVE
FRANKLIN VA
23851
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-8770
  • Fax: 757-683-9211
Mailing address:
  • Phone: 757-569-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101030380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: