MEDICARE: DANTE NEISONE 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	208000000X	Pediatrics Physician	2019-00846	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	AA23878552	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30392	OTHER	SC	SC MEDICAL LICENSE
2	4001444	OTHER	SC	CIGNA
3	9630227	OTHER	SC	AETNA
4	20069023	OTHER	SC	SELECT HEALTH
6	2019-00846	OTHER	NC	NC MEDICAL LICENSE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	18500	OTHER	SC	EVOLUTIONS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508843442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANTE NEISONE LEWIS MD

Provider Business Mailing Address
First Line	:	530 W WEBB AVE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27217-3706
Country	:	US
Telephone Number	:	336-228-8316
Fax Number	:	336-227-9750

Provider Business Practice Location Address
First Line	:	3940 ARROWHEAD BLVD STE 270
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302-7637
Country	:	US
Telephone Number	:	919-563-0202
Fax Number	:	919-563-0242

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	10/22/2019

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Directions to “ DANTE NEISONE LEWIS MD” Practice Location

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