Healthcare Provider Details

I. General information

NPI: 1942206255
Provider Name (Legal Business Name): PHILIP ALDEN LEWIS JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST VA MEDICAL CENTER (112)
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

315 TWIN PONDS LN
VASS NC
28394-9266
US

V. Phone/Fax

Practice location:
  • Phone: 910-822-7131
  • Fax: 910-822-7035
Mailing address:
  • Phone: 901-822-7131
  • Fax: 910-822-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD 209
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: