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General NPI Number Information
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NPI Number | 1205995578
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Entity Type | Individual
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Provider Name | BRUCE DONALD LEWIS JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 10210 REISTERSTOWN RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3606
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Country | US
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Telephone | 410-902-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 STARBOARD CT
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City | EDGEWOOD
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State | MD
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Zip | 21040-1340
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Country | US
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Telephone | 410-612-2178
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0002016
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License Number State | MD
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