Provider Demographics
NPI:1023004488
Name:LEWIS, RALPH MORGAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MORGAN
Last Name:LEWIS
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 1:1511 BIG POND ROAD
Mailing Address - Street 2:APT. 3
Mailing Address - City:COLUMBIA CROSS ROADS
Mailing Address - State:PA
Mailing Address - Zip Code:16914-8237
Mailing Address - Country:US
Mailing Address - Phone:570-596-3022
Mailing Address - Fax:
Practice Address - Street 1:1511 BIG POND ROAD
Practice Address - Street 2:APT. 3
Practice Address - City:COLUMBIA CROSS ROADS
Practice Address - State:PA
Practice Address - Zip Code:16914-8237
Practice Address - Country:US
Practice Address - Phone:570-596-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005202207Q00000X
PAOS005378L207Q00000X
CA20A6190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023004488OtherNPI
OH0198745Medicaid
OHLE 0683151Medicare ID - Type Unspecified
OH0198745Medicaid