Provider Demographics
NPI:1821122938
Name:BURWELL, EDWIN RAMON (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:RAMON
Last Name:BURWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 HOME ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2073
Mailing Address - Country:US
Mailing Address - Phone:315-278-7064
Mailing Address - Fax:
Practice Address - Street 1:266 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4104
Practice Address - Country:US
Practice Address - Phone:212-690-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine