Provider Demographics
NPI:1003873068
Name:MAHRAN, LEWIS A (DO)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:A
Last Name:MAHRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W MAIN ST STE 330
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3384
Mailing Address - Country:US
Mailing Address - Phone:937-980-7400
Mailing Address - Fax:937-980-7409
Practice Address - Street 1:1250 W NATIONAL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45315-9505
Practice Address - Country:US
Practice Address - Phone:937-836-2424
Practice Address - Fax:937-832-4805
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015090Medicaid
OH2015090Medicaid
OHH410100Medicare PIN
G54125Medicare UPIN