1962455519 NPI number — DR. ALBERT READ LEWIN M.D.

Table of content: DR. ALBERT READ LEWIN M.D. (NPI 1962455519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962455519 NPI number — DR. ALBERT READ LEWIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIN
Provider First Name:
ALBERT
Provider Middle Name:
READ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1962455519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 PARRIS ISLAND GTWY
Provider Second Line Business Mailing Address:
SUITE B2
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29906-6921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-986-9292
Provider Business Mailing Address Fax Number:
843-986-9292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 PARRIS ISLAND GTWY
Provider Second Line Business Practice Location Address:
SUITE B2
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29906-6921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-986-9292
Provider Business Practice Location Address Fax Number:
843-986-9292
Provider Enumeration Date:
05/17/2006

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: 174400000X , with the licence number:  11027 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YX0602X , with the licence number: 11207 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 11207 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110276 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202019697 . This is a "MULTIPLAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 202019697 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20045633 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 202019697 . This is a "BLUE CHOICE (COMPANION)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00269415 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 202019697 . This is a "HEALTHCARE SAVINGS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 202019697 . This is a "PREMIER HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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