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General NPI Number Information
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NPI Number | 1639619224
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Entity Type | Organization
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Legal Business Name | LEWIS PRIMARY CARE, P.A.
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 04/30/2017
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Provider Practice Location Address
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Address Line | 1324 BELMONT AVE UNIT 103
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City | SALISBURY
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State | MD
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Zip | 21804-4584
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Country | US
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Telephone | 443-978-7383
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Fax | 443-978-7598
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Provider Business Mailing Address
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Address Line | 1324 BELMONT AVE UNIT 103
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City | SALISBURY
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State | MD
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Zip | 21804-4584
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Country | US
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Telephone | 443-978-7383
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Fax | 443-978-7598
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Authorized Official
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Title or Position | OWNER
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Name | MR. VINCENT WALTER LEWIS
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Credential | PA-C
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Telephone | 443-978-7383
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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 |
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License Number State |
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