MEDICARE: DR. LEWIS BAKER EBERLY 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	2084N0400X	Neurology Physician	0101045384	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841282555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS BAKER EBERLY M.D.

Provider Business Mailing Address
First Line	:	1500 N BEAUREGARD ST
Second Line	:	SUITE 300
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1723
Country	:	US
Telephone Number	:	703-845-1500
Fax Number	:	703-845-1300

Provider Business Practice Location Address
First Line	:	1500 N BEAUREGARD STREET
Second Line	:	SUITE 300
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1715
Country	:	US
Telephone Number	:	703-845-1500
Fax Number	:	703-845-1300

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	11/27/2023

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