Provider Demographics
NPI:1841230844
Name:BURWELL, JOHN SPOTSWOOD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SPOTSWOOD
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:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-0093
Mailing Address - Country:US
Mailing Address - Phone:800-800-1617
Mailing Address - Fax:866-759-5426
Practice Address - Street 1:1440 HIGHWAY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1951
Practice Address - Country:US
Practice Address - Phone:256-241-2230
Practice Address - Fax:256-241-2235
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14175207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114270Medicaid
MSF24571Medicare UPIN
MS00114270Medicaid
MS050000695Medicare Oscar/Certification