Provider Demographics
NPI:1003814005
Name:LEWIS, JOHN WARREN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARREN
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-526-2121
Mailing Address - Fax:804-520-2617
Practice Address - Street 1:436 CLAIRMONT CT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1765
Practice Address - Country:US
Practice Address - Phone:804-526-2121
Practice Address - Fax:804-520-2617
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-02-05
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Provider Licenses
StateLicense IDTaxonomies
VA0102201012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005645344Medicaid
1003814005Medicare NSC
VAH51102Medicare UPIN