Healthcare Provider Details

I. General information

NPI: 1578259586
Provider Name (Legal Business Name): CRYSTAL LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-5538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0107226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: