Provider Demographics
NPI:1144614215
Name:LEWIS, DENISE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FINISHING MILL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EDGEMERE
Mailing Address - State:MD
Mailing Address - Zip Code:21219-1058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 FINISHING MILL RD STE 104
Practice Address - Street 2:
Practice Address - City:EDGEMERE
Practice Address - State:MD
Practice Address - Zip Code:21219-1058
Practice Address - Country:US
Practice Address - Phone:443-266-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant