MEDICARE: DORETHA 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	2255A2300X	Athletic Trainer
2	2279P1005X	Pulmonary Rehabilitation Registered Respiratory Therapist

General Provider Information

NPI Number	:	1306561923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORETHA LEWIS

Provider Business Mailing Address
First Line	:	9301 ANNAPOLIS RD
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 INDUSTRIAL PARK DR STE A
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2792
Country	:	US
Telephone Number	:	301-638-7543
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Directions to “ DORETHA LEWIS ” Practice Location

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