Provider Demographics
NPI:1104855055
Name:LEWIN, BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
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 1:3264 PAPER MILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3720
Mailing Address - Country:US
Mailing Address - Phone:215-776-0499
Mailing Address - Fax:
Practice Address - Street 1:3264 PAPER MILL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3720
Practice Address - Country:US
Practice Address - Phone:215-776-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035816E208D00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01109202Medicaid
PA01109202Medicaid
PA511120QUMMedicare ID - Type Unspecified