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General NPI Number Information
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NPI Number | 1508058009
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Entity Type | Individual
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Provider Name | WENDELL R LEWIS JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 45 HUNT CLUB DR
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City | RIDGELEY
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State | WV
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Zip | 26753-7567
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Country | US
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Telephone | 304-726-4501
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Fax | 304-726-4051
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Provider Business Mailing Address
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Address Line | 1200 J D ANDERSON DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-3494
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Country | US
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Telephone | 304-598-1200
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 01323
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C05465
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 01323
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License Number State | WV
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