Provider Demographics
NPI:1083616361
Name:LEA, JEWA MARIA (DC)
Entity Type:Individual
Prefix:DR
First Name:JEWA
Middle Name:MARIA
Last Name:LEA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12501 SILVERBIRCH LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2508
Mailing Address - Country:US
Mailing Address - Phone:301-421-1420
Mailing Address - Fax:301-421-1426
Practice Address - Street 1:15202 DINO DR
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1172
Practice Address - Country:US
Practice Address - Phone:301-421-1420
Practice Address - Fax:301-421-1426
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1976111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic