MEDICARE: ANDREA TEWELL D.O.

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	34006472	OH

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

General Provider Information

NPI Number	:	1891790754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA TEWELL D.O.

Provider Business Mailing Address
First Line	:	909 E 2ND ST
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1700
Country	:	US
Telephone Number	:	937-746-8357
Fax Number	:	937-746-1992

Provider Business Practice Location Address
First Line	:	909 E 2ND ST
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1712
Country	:	US
Telephone Number	:	937-746-8357
Fax Number	:	937-746-1992

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/18/2020

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