Healthcare Provider Details

I. General information

NPI: 1013700640
Provider Name (Legal Business Name): NOAH DANIEL HURST LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST. YAWHAY OUTPATIENT CENTER -5B
BOSTON MA
02114
US

IV. Provider business mailing address

21 CHARLES ST APT. 604
CAMBRIDGE MA
02141
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-7117
  • Fax: 617-643-7222
Mailing address:
  • Phone: 857-270-4790
  • Fax: 956-625-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number3017835
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3017835
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3017835
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3017835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: