Provider Demographics
NPI:1003921313
Name:LEWIS, RANDALL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JEFFREY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-657-1996
Mailing Address - Fax:301-951-6160
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-657-1996
Practice Address - Fax:301-951-6160
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC9098207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC87815Medicare UPIN
DC020343M60Medicare PIN