Healthcare Provider Details

I. General information

NPI: 1023575016
Provider Name (Legal Business Name): KATHERINE ROSE LEWIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 11
TIMONIUM MD
21093-6211
US

IV. Provider business mailing address

1205 YORK RD STE 11
TIMONIUM MD
21093-6211
US

V. Phone/Fax

Practice location:
  • Phone: 443-325-0031
  • Fax:
Mailing address:
  • Phone: 443-325-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: