Provider Demographics
NPI:1619947405
Name:BURWELL, RICHARD KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEITH
Last Name:BURWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1ST MEDICAL GROUP
Mailing Address - Street 2:45 PINE ROAD
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2080
Mailing Address - Country:US
Mailing Address - Phone:757-764-6090
Mailing Address - Fax:757-225-1411
Practice Address - Street 1:1ST MEDICAL GROUP
Practice Address - Street 2:45 PINE ROAD
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2080
Practice Address - Country:US
Practice Address - Phone:757-764-6090
Practice Address - Fax:757-225-1411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102033533207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology