Provider Demographics
NPI:1093920043
Name:LEWIN, ROGER AMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:AMOS
Last Name:LEWIN
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 1:504 CLUB LN
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7302
Mailing Address - Country:US
Mailing Address - Phone:410-828-7045
Mailing Address - Fax:410-938-4444
Practice Address - Street 1:504 CLUB LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-7302
Practice Address - Country:US
Practice Address - Phone:410-828-7045
Practice Address - Fax:410-938-4444
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD273292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5531Medicare ID - Type Unspecified
MDD77762Medicare UPIN