MEDICARE: RANDALL LAWRENCE BURCHELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1752231	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1752231	OTHER		LICENSE

General Provider Information

NPI Number	:	1407827462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL LAWRENCE BURCHELL MD

Provider Business Mailing Address
First Line	:	3044 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2906
Country	:	US
Telephone Number	:	518-886-5800
Fax Number	:	518-886-5805

Provider Business Practice Location Address
First Line	:	3044 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1143
Country	:	US
Telephone Number	:	518-886-5800
Fax Number	:	518-886-5805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/07/2023

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