Provider Demographics
NPI:1013024157
Name:LEWIS, KATHLEEN CLAIRE
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CLAIRE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FOUR MILE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1940
Mailing Address - Country:US
Mailing Address - Phone:570-327-1000
Mailing Address - Fax:570-323-6079
Practice Address - Street 1:1701 FOUR MILE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1940
Practice Address - Country:US
Practice Address - Phone:570-327-1000
Practice Address - Fax:570-323-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005446L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE13046Medicare UPIN
PALE555734Medicare ID - Type Unspecified