MEDICARE: SEAN LAMONT LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1093568743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN LAMONT LEWIS

Provider Business Mailing Address
First Line	:	303 POWDERSBY RD
Second Line	:
City	:	JOPPA
State	:	MD
Zip	:	21085-5422
Country	:	US
Telephone Number	:	757-620-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	8525 GEORGIA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3402
Country	:	US
Telephone Number	:	301-588-3232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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Directions to “ SEAN LAMONT LEWIS ” Practice Location

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