1386601615 NPI number — DR. STEVEN L LEWIS MD

Table of content: DR. STEVEN L LEWIS MD (NPI 1386601615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386601615 NPI number — DR. STEVEN L LEWIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
STEVEN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386601615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 783311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-884-4500
Provider Business Mailing Address Fax Number:
484-884-0699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3701 CORRIERE RD STE 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18045-7991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-591-7120
Provider Business Practice Location Address Fax Number:
484-591-7121
Provider Enumeration Date:
04/28/2006

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: 2084V0102X , with the licence number:  MD462426 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: 03069914 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD462426 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 036069914 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS336033848 . This is a "IL DEPT OF FE PROF REG" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".