Healthcare Provider Details

I. General information

NPI: 1922470905
Provider Name (Legal Business Name): CONSTANTINE LEWKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 70TH AVE
NEW CARROLLTON MD
20784-2116
US

IV. Provider business mailing address

4210 70TH AVE
NEW CARROLLTON MD
20784-2116
US

V. Phone/Fax

Practice location:
  • Phone: 202-464-0517
  • Fax:
Mailing address:
  • Phone: 202-464-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1028826
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR203918
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1028826
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: