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General NPI Number Information
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NPI Number | 1104976562
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Entity Type | Individual
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Provider Name | MARC ROY LEWIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 1355 RIVER BEND DR
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City | DALLAS
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State | TX
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Zip | 75247-4915
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Country | US
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Telephone | 214-237-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 2829 WESTMINSTER AVE
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City | DALLAS
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State | TX
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Zip | 75205-1506
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Country | US
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Telephone | 214-265-1225
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD430595
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License Number State | PA
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