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General NPI Number Information
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NPI Number | 1801073499
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Entity Type | Organization
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Legal Business Name | DRS BRAD & ELAINE LEWIS MD LLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 1147 E MAIN ST
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City | LANCASTER
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State | OH
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Zip | 43130-4056
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Country | US
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Telephone | 740-687-9173
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Fax | 740-689-3740
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Provider Business Mailing Address
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Address Line | 1147 E MAIN ST
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City | LANCASTER
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State | OH
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Zip | 43130-4056
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Country | US
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Telephone | 740-687-9173
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Fax | 740-689-3740
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Authorized Official
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Title or Position | CONTRACT/CREDENTIALING MANAGER
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Name | MR. MATTHEW T WOLF
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Credential | BSBA
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Telephone | 740-687-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35059549
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License Number State | OH
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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 | 35056043
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License Number State | OH
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