Healthcare Provider Details

I. General information

NPI: 1356800619
Provider Name (Legal Business Name): CALLUM BIX LEWANDROWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 CHEAT RD
MORGANTOWN WV
26508-4210
US

IV. Provider business mailing address

PO BOX 780
MORGANTOWN WV
26507-0780
US

V. Phone/Fax

Practice location:
  • Phone: 855-988-2273
  • Fax: 304-594-2408
Mailing address:
  • Phone: 681-342-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number3370
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3370
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: