Provider Demographics
NPI:1093919060
Name:SAMUEL J. LEWIS, M.D., INC.
Entity Type:Organization
Organization Name:SAMUEL J. LEWIS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-253-1199
Mailing Address - Street 1:15 ALTARINDA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2607
Mailing Address - Country:US
Mailing Address - Phone:925-253-1199
Mailing Address - Fax:925-253-1110
Practice Address - Street 1:15 ALTARINDA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2607
Practice Address - Country:US
Practice Address - Phone:925-253-1199
Practice Address - Fax:925-253-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty