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1528089612

NPI Code Detail

MEDICARE: MR. MYRON L SEWELL MD

MEDICARE: MR. MYRON L SEWELL 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	207R00000X	Internal Medicine Physician	MD031348E	PA
2	207R00000X	Internal Medicine Physician	25MA04169400	NJ

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	00548140000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528089612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MYRON L SEWELL MD

Provider Business Mailing Address
First Line	:	5201 HAVERFORD AVE.
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1401
Country	:	US
Telephone Number	:	215-471-2761
Fax Number	:	215-472-6093

Provider Business Practice Location Address
First Line	:	5201 HAVERFORD AVE.
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1401
Country	:	US
Telephone Number	:	215-471-2761
Fax Number	:	215-472-6093

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	12/05/2019

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Directions to “ MR. MYRON L SEWELL MD” Practice Location

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