Healthcare Provider Details

I. General information

NPI: 1518979368
Provider Name (Legal Business Name): ANNA V LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

10 ORMS ST SUITE 105
PROVIDENCE RI
02904-2228
US

V. Phone/Fax

Practice location:
  • Phone: 401-854-2500
  • Fax: 401-453-9619
Mailing address:
  • Phone: 401-854-2500
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD07652
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD07652
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: