Healthcare Provider Details

I. General information

NPI: 1457319048
Provider Name (Legal Business Name): WILLIAM DARRELL LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TAYLOR ST
HARPERS FERRY WV
25425-3641
US

IV. Provider business mailing address

2500 FOUNDATION WAY
MARTINSBURG WV
25401-9000
US

V. Phone/Fax

Practice location:
  • Phone: 304-535-6343
  • Fax: 304-535-6618
Mailing address:
  • Phone: 304-264-9202
  • Fax: 304-264-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20431
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20431
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: