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NPI Code Detail

MEDICARE: KATHLEEN ELIZABETH LEWIS DO

MEDICARE: KATHLEEN ELIZABETH LEWIS DO
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
1207Q00000XFamily Medicine Physician231291NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194726125
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ELIZABETH LEWIS DO
Provider Business Mailing Address
First Line : 346 GRAND AVE
Second Line :
City : JOHNSON CITY
State : NY
Zip : 13790-2558
Country : US
Telephone Number : 607-770-0025
Fax Number : 607-729-3982
Provider Business Practice Location Address
First Line : 1302 E MAIN ST
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5430
Country : US
Telephone Number : 607-754-7171
Fax Number : 607-754-3033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 03/18/2021

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Directions to “ KATHLEEN ELIZABETH LEWIS DO” Practice Location

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