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General NPI Number Information
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NPI Number | 1790770386
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Entity Type | Individual
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Provider Name | MARY LOU LEWIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 501 MORRIS STREET CAMC
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City | CHARLESTON
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State | WV
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Zip | 25301
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Country | US
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Telephone | 304-388-7191
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Fax |
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Provider Business Mailing Address
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Address Line | 7026 VALLEY BROOK DRIVE
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City | CHARLESTON
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State | WV
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Zip | 25312-9460
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Country | US
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Telephone | 304-984-3013
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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 | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 9415
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 9415
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License Number State | WV
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