Healthcare Provider Details

I. General information

NPI: 1326051889
Provider Name (Legal Business Name): HARRY LEWIS GEWANTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
RICHMOND VA
23219
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax: 804-827-1771
Mailing address:
  • Phone: 804-358-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number0101035749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: