Healthcare Provider Details

I. General information

NPI: 1598766115
Provider Name (Legal Business Name): JENNIFER L LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WATERDAM RD STE 120
MC MURRAY PA
15317-2573
US

IV. Provider business mailing address

157 WATERDAM RD STE 120
MC MURRAY PA
15317-2573
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-6697
  • Fax: 724-941-7563
Mailing address:
  • Phone: 724-941-6697
  • Fax: 724-941-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD069652L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: