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General NPI Number Information
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NPI Number | 1487817466
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Entity Type | Individual
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Provider Name | CHANTAL D LEWIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 04/11/2020
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Provider Practice Location Address
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Address Line | 3122 GOLANSKY BLVD STE 101
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4267
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Country | US
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Telephone | 571-989-4134
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Fax | 703-774-3939
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Provider Business Mailing Address
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Address Line | 3122 GOLANSKY BLVD STE 101
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4267
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Country | US
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Telephone | 571-989-4134
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Fax | 703-774-3939
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD038499
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0069954
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101245466
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License Number State | VA
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