Provider Demographics
NPI:1528089612
Name:SEWELL, MYRON L (MD)
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:L
Last Name:SEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 HAVERFORD AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1401
Mailing Address - Country:US
Mailing Address - Phone:215-471-2761
Mailing Address - Fax:215-472-6093
Practice Address - Street 1:5201 HAVERFORD AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1401
Practice Address - Country:US
Practice Address - Phone:215-471-2761
Practice Address - Fax:215-472-6093
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031348E207R00000X
NJ25MA04169400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA009858110Medicaid
PA00548140000OtherKEYSTONE HEALTH PLAN EAST
PA009858110002Medicaid
PA009858110Medicaid