MEDICARE: LEWIS FAMILY PRACTICE PC

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	207Q00000X	Family Medicine Physician	MD059944L	PA

General Provider Information

NPI Number	:	1790795995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	SUITE #2208
City	:	MEDIA
State	:	PA
Zip	:	19063-5146
Country	:	US
Telephone Number	:	610-891-3049
Fax Number	:	610-891-3919

Provider Business Practice Location Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	SUITE #2208
City	:	MEDIA
State	:	PA
Zip	:	19063-5146
Country	:	US
Telephone Number	:	610-891-3049
Fax Number	:	610-891-3919

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHELE MILLER
Credential	:
Telephone Number	:	610-891-3905

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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Directions to “LEWIS FAMILY PRACTICE PC ” Practice Location

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