MEDICARE: MRS. VERNA M LEWIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	0101042565	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00348816	OTHER		MEDICARE RAILROAD

General Provider Information

NPI Number	:	1144334970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERNA M LEWIS MD

Provider Business Mailing Address
First Line	:	PO BOX 4127
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-0127
Country	:	US
Telephone Number	:	540-981-9394
Fax Number	:	540-344-7154

Provider Business Practice Location Address
First Line	:	2328 PETERS CREEK RD NW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24017-1621
Country	:	US
Telephone Number	:	540-400-7765
Fax Number	:	540-400-7555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/01/2012

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