Healthcare Provider Details

I. General information

NPI: 1760445332
Provider Name (Legal Business Name): LAWRENCE MICHAEL LEWKOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 HARBOURSIDE CENTRE LOOP STE 101
MIDLOTHIAN VA
23112-2170
US

IV. Provider business mailing address

7202 GLEN FOREST DR SUITE 200
RICHMOND VA
23226-3781
US

V. Phone/Fax

Practice location:
  • Phone: 804-378-0394
  • Fax: 804-739-7649
Mailing address:
  • Phone: 804-673-0134
  • Fax: 804-673-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101049920
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: