Healthcare Provider Details

I. General information

NPI: 1659361723
Provider Name (Legal Business Name): CHRISTINE P LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD SUITE 246
HAGERSTOWN MD
21742-6700
US

IV. Provider business mailing address

11110 MEDICAL CAMPUS RD SUITE 246
HAGERSTOWN MD
21742-6700
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-4585
  • Fax: 301-665-4587
Mailing address:
  • Phone: 301-665-4585
  • Fax: 301-665-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD54630
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: