Healthcare Provider Details

I. General information

NPI: 1396717013
Provider Name (Legal Business Name): DANA MARIE LEWIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 LAURENS RD
GREENVILLE SC
29607-5236
US

IV. Provider business mailing address

PO BOX 604308
CHARLOTTE NC
28260-4308
US

V. Phone/Fax

Practice location:
  • Phone: 864-537-4600
  • Fax: 855-858-0464
Mailing address:
  • Phone: 804-273-8014
  • Fax: 855-858-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number100716
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53354
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7088
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93933
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: