Provider Demographics
NPI:1033190590
Name:LEWIS, EDWARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DAVID
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 1:880 WESTFALL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2611
Mailing Address - Country:US
Mailing Address - Phone:585-442-1421
Mailing Address - Fax:585-442-6882
Practice Address - Street 1:880 WESTFALL RD
Practice Address - Street 2:SUITE E
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2611
Practice Address - Country:US
Practice Address - Phone:585-442-1421
Practice Address - Fax:585-442-6882
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00564925Medicaid
NY00564925Medicaid