Healthcare Provider Details

I. General information

NPI: 1427595503
Provider Name (Legal Business Name): ANGELA KORLESKI LEWIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-5332
  • Fax:
Mailing address:
  • Phone: 919-828-0890
  • Fax: 919-719-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07032
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: