MEDICARE: MARSHALL CORYDON 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	2080P0202X	Pediatric Cardiology Physician	ME78926	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386698686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL CORYDON LEWIS MD

Provider Business Mailing Address
First Line	:	5325 GREENWOOD AVE
Second Line	:	SUITE #302
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2452
Country	:	US
Telephone Number	:	561-844-9858
Fax Number	:	561-844-3436

Provider Business Practice Location Address
First Line	:	5325 GREENWOOD AVE
Second Line	:	SUITE #302
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2452
Country	:	US
Telephone Number	:	561-844-9858
Fax Number	:	561-844-3436

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/12/2024

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