MEDICARE: DR. MARTIN GWENT LEWIS M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME43645	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1326070962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN GWENT LEWIS M.D.

Provider Business Mailing Address
First Line	:	6501 PASADENA AVENUE, NORTH
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33710
Country	:	US
Telephone Number	:	727-343-3545
Fax Number	:	727-343-3681

Provider Business Practice Location Address
First Line	:	6501 PASADENA AVENUE, NORTH
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33710
Country	:	US
Telephone Number	:	727-343-3545
Fax Number	:	727-343-3681

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/08/2012

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Directions to “ DR. MARTIN GWENT LEWIS M.D.” Practice Location

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