MEDICARE: DR. KERRY LEWIS M.D.

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	207VM0101X	Maternal & Fetal Medicine Physician	20753	DC

General Provider Information

NPI Number	:	1184624918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY LEWIS M.D.

Provider Business Mailing Address
First Line	:	2041 GEORGIA AVE NW
Second Line	:	OBGYN ADMINISTRATIVE SUITE
City	:	WASHINGTON
State	:	DC
Zip	:	20060-0001
Country	:	US
Telephone Number	:	202-865-1164
Fax Number	:	202-865-7532

Provider Business Practice Location Address
First Line	:	2041 GEORGIA AVE NW
Second Line	:	OBGYN ADMINISTRATIVE SUITE
City	:	WASHINGTON
State	:	DC
Zip	:	20060-0001
Country	:	US
Telephone Number	:	202-865-1164
Fax Number	:	202-865-7532

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	12/22/2008

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