MEDICARE: FRED H. LEWIS MD

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	207K00000X	Allergy & Immunology Physician	131715	NY
2	2080P0201X	Pediatric Allergy/Immunology Physician	131715	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	00010264202	OTHER	UNIVERA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0206516	OTHER	IHA
4	000500015002	OTHER	BC/BS
5	040426004096	OTHER	FIDELIS

General Provider Information

NPI Number	:	1093714230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED H. LEWIS MD

Provider Business Mailing Address
First Line	:	535 MAIN ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1500
Country	:	US
Telephone Number	:	716-372-0141
Fax Number	:	716-376-2451

Provider Business Practice Location Address
First Line	:	535 MAIN ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1500
Country	:	US
Telephone Number	:	716-372-0141
Fax Number	:	716-376-2451

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	02/16/2012

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Directions to “ FRED H. LEWIS MD” Practice Location

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