Provider Demographics
NPI:1083744833
Name:LEWIS, BENJAMIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:F
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 DEVON PARK
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8527
Mailing Address - Country:US
Mailing Address - Phone:864-229-2811
Mailing Address - Fax:864-229-2811
Practice Address - Street 1:LEATH CORRECTIONAL INSTITUTE FOR WOMEN
Practice Address - Street 2:2809 AIRPORT RD.
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9212
Practice Address - Country:US
Practice Address - Phone:803-896-1035
Practice Address - Fax:803-896-1049
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10390 77Medicaid
D99407Medicare UPIN