Healthcare Provider Details

I. General information

NPI: 1346877131
Provider Name (Legal Business Name): JOHN CHRISTOPHER LEWIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST DEPARTMENT OF EMERGENCY MEDICINE
PORTLAND ME
04102
US

IV. Provider business mailing address

22 BRAMHALL ST DEPARTMENT OF EMERGENCY MEDICINE
PORTLAND ME
04102
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2381
  • Fax:
Mailing address:
  • Phone: 207-662-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64328
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25337
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO3526
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: