MEDICARE: TAKERIA 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1821610361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKERIA LEWIS

Provider Business Mailing Address
First Line	:	300 KARL LINN DR APT 115
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-6979
Country	:	US
Telephone Number	:	804-773-5295
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 KARL LINN DR APT 115
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-6979
Country	:	US
Telephone Number	:	804-773-5295
Fax Number	:

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

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	06/01/2020

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Directions to “ TAKERIA LEWIS ” Practice Location

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