MEDICARE: PAMELA L. 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	207V00000X	Obstetrics & Gynecology Physician	032602	CT

General Provider Information

NPI Number	:	1366404949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA L. LEWIS M.D.

Provider Business Mailing Address
First Line	:	360 TOLLAND TPKE
Second Line	:	SUITE 3B
City	:	MANCHESTER
State	:	CT
Zip	:	06042-1771
Country	:	US
Telephone Number	:	860-646-1157
Fax Number	:	860-646-9877

Provider Business Practice Location Address
First Line	:	360 TOLLAND TPKE
Second Line	:	SUITE 3B
City	:	MANCHESTER
State	:	CT
Zip	:	06042-1771
Country	:	US
Telephone Number	:	860-646-1157
Fax Number	:	860-646-9877

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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