Provider Demographics
NPI:1093774747
Name:MARTIN, LEWIS PAUL (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:PAUL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3148
Mailing Address - Street 2:1803 FOREST HILLS ROAD
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3148
Mailing Address - Country:US
Mailing Address - Phone:252-243-9629
Mailing Address - Fax:252-243-0915
Practice Address - Street 1:1803 FOREST HILLS ROAD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-243-9629
Practice Address - Fax:252-243-0915
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500357207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS9D1142Medicaid
2044790Medicare ID - Type Unspecified
NCS9D1142Medicaid