Healthcare Provider Details

I. General information

NPI: 1184624918
Provider Name (Legal Business Name): KERRY LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW OBGYN ADMINISTRATIVE SUITE
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2041 GEORGIA AVE NW OBGYN ADMINISTRATIVE SUITE
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-1164
  • Fax: 202-865-7532
Mailing address:
  • Phone: 202-865-1164
  • Fax: 202-865-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number20753
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: