Provider Demographics
NPI:1073959045
Name:LEWIN, GRADY (BOCP, CFO)
Entity Type:Individual
Prefix:
First Name:GRADY
Middle Name:
Last Name:LEWIN
Suffix:
Gender:M
Credentials:BOCP, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2287
Mailing Address - Country:US
Mailing Address - Phone:207-762-3808
Mailing Address - Fax:207-762-3809
Practice Address - Street 1:40 NORTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2287
Practice Address - Country:US
Practice Address - Phone:207-762-3808
Practice Address - Fax:207-762-3809
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information