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General NPI Number Information
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NPI Number | 1487849485
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Entity Type | Organization
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Legal Business Name | SANDRA J LEWIS M.D. P.L.L.C.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 4004 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1672
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Country | US
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Telephone | 304-926-0172
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Fax |
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Provider Business Mailing Address
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Address Line | 4004 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1672
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Country | US
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Telephone | 304-926-0172
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SANDRA J LEWIS
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Credential | MD
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Telephone | 304-926-0172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 18980
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License Number State | WV
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