Healthcare Provider Details

I. General information

NPI: 1831160399
Provider Name (Legal Business Name): BEVERLY ANN LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY A LEWIS MD PA

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 US HIGHWAY 64 E
PLYMOUTH NC
27962-9216
US

IV. Provider business mailing address

PO BOX 884 405 MCCASKEY RD
WILLIAMSTON NC
27892
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-1010
  • Fax: 252-793-4113
Mailing address:
  • Phone: 252-792-6071
  • Fax: 252-792-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: