Healthcare Provider Details

I. General information

NPI: 1114901030
Provider Name (Legal Business Name): RAYMOND HERBERT LEWIS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLARK RD SUITE 3
TEWKSBURY MA
01876-1699
US

IV. Provider business mailing address

600 CLARK RD SUITE 3
TEWKSBURY MA
01876-1699
US

V. Phone/Fax

Practice location:
  • Phone: 978-851-4141
  • Fax: 978-788-7911
Mailing address:
  • Phone: 978-851-4141
  • Fax: 978-788-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD10943
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0064713
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: