Provider Demographics
NPI:1225127905
Name:MEHL-MADRONA, LEWIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:E
Last Name:MEHL-MADRONA
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 1:288 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3433
Mailing Address - Country:US
Mailing Address - Phone:808-772-1099
Mailing Address - Fax:207-406-5354
Practice Address - Street 1:288 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3433
Practice Address - Country:US
Practice Address - Phone:808-772-1099
Practice Address - Fax:207-406-5354
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD199032084P0800X, 207Q00000X
VT42-0008285207QG0300X, 207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03249176Medicaid
PA541389OtherHIGHMARK