Healthcare Provider Details

I. General information

NPI: 1396484259
Provider Name (Legal Business Name): JUSTINE LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY DEPT OF
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2284
  • Fax: 410-554-2184
Mailing address:
  • Phone: 410-933-0000
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD0106921
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: