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General NPI Number Information
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NPI Number | 1104662386
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Entity Type | Individual
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Provider Name | KOURTNY DEANA LEWIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 5710 SILVER HILL RD
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-1101
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Country | US
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Telephone | 301-736-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 7903 PRENTICE CT
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4449
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Country | US
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Telephone | 240-605-3833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0010076
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License Number State | MD
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