1255391868 NPI number — DR. CYNTHIA RHEA LEWIS-YOUNGER MD, MPH

Table of content: DR. CYNTHIA RHEA LEWIS-YOUNGER MD, MPH (NPI 1255391868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255391868 NPI number — DR. CYNTHIA RHEA LEWIS-YOUNGER MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS-YOUNGER
Provider First Name:
CYNTHIA
Provider Middle Name:
RHEA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
RHEA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255391868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 HILLTOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHOUGAL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98671-7222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-321-9776
Provider Business Mailing Address Fax Number:
813-246-4654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 HILLTOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHOUGAL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-321-9776
Provider Business Practice Location Address Fax Number:
813-246-4654
Provider Enumeration Date:
03/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083T0002X , with the licence number:  MD00040364 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083T0002X , with the licence number: MD173259 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X , with the licence number: MD173259 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MD00040364 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MD173259 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X , with the licence number: MD00040364 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CA7094 . This is a "MEDICARE TRAVELERS GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 650622862043 . This is a "CHAMPUS-TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 055237201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".