Healthcare Provider Details

I. General information

NPI: 1376526459
Provider Name (Legal Business Name): EDWARD ALBERT LEW M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE 111-GI
JAMAICA PLAIN MA
02130-4817
US

IV. Provider business mailing address

150 S. HUNTINGTON AVENUE, 111-GI
JAMAICA PLAIN MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax: 857-364-4179
Mailing address:
  • Phone: 857-364-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number207034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: