Provider Demographics
NPI:1104866060
Name:LEWIS, ERIC ALDEN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALDEN
Last Name:LEWIS
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 1:125 N. ROBERTSON BLVD.
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-289-9700
Mailing Address - Fax:310-289-9779
Practice Address - Street 1:125 N. ROBERTSON BLVD.
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2103
Practice Address - Country:US
Practice Address - Phone:310-289-9700
Practice Address - Fax:310-289-9779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG358260207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35826Medicare PIN
CAA46489Medicare UPIN