Provider Demographics
NPI:1124000419
Name:LEWIS, BRIAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
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 1:1219 LEXINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2784
Mailing Address - Country:US
Mailing Address - Phone:336-475-7148
Mailing Address - Fax:336-475-7031
Practice Address - Street 1:1219 LEXINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2784
Practice Address - Country:US
Practice Address - Phone:336-475-7148
Practice Address - Fax:336-475-7031
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200720208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131RAOtherNC BCBS PROVIDER #
NC89131RAMedicaid
NCNC4256AMedicare PIN