Provider Demographics
NPI:1205968666
Name:BURWELL, CAROLYN SMITH (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SMITH
Last Name:BURWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33266 EDGEHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851
Mailing Address - Country:US
Mailing Address - Phone:757-569-8249
Mailing Address - Fax:
Practice Address - Street 1:830 SOUTHAMPTON AVENUE
Practice Address - Street 2:NORFOLK DEPT OF PUBLIC HEALTH
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-683-8770
Practice Address - Fax:757-683-9211
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030380208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74852Medicare UPIN