Healthcare Provider Details

I. General information

NPI: 1104866060
Provider Name (Legal Business Name): ERIC ALDEN LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N. ROBERTSON BLVD.
BEVERLY HILLS CA
90211-2103
US

IV. Provider business mailing address

125 N. ROBERTSON BLVD.
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-9700
  • Fax: 310-289-9779
Mailing address:
  • Phone: 310-289-9700
  • Fax: 310-289-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG358260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: