Healthcare Provider Details

I. General information

NPI: 1932199643
Provider Name (Legal Business Name): RONALD LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SPRINGVIEW LN UNIT B
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

85 SPRINGVIEW LN UNIT B
SUMMERVILLE SC
29485-8119
US

V. Phone/Fax

Practice location:
  • Phone: 843-620-2794
  • Fax:
Mailing address:
  • Phone: 843-823-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME97943
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number209462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: