MEDICARE: EDWIN RAMON BURWELL 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	239073	NY

General Provider Information

NPI Number	:	1821122938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN RAMON BURWELL MD

Provider Business Mailing Address
First Line	:	1014 HOME ST
Second Line	:	APT 2C
City	:	BRONX
State	:	NY
Zip	:	10459-2073
Country	:	US
Telephone Number	:	315-278-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 W 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-4104
Country	:	US
Telephone Number	:	212-690-4002
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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