Provider Demographics
NPI:1235409848
Name:LEWIS, REBECCA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FOREST AVENUE
Mailing Address - Street 2:PO BOX 388
Mailing Address - City:EAGLES MERE
Mailing Address - State:PA
Mailing Address - Zip Code:17731-0388
Mailing Address - Country:US
Mailing Address - Phone:215-266-0769
Mailing Address - Fax:
Practice Address - Street 1:122 FOREST AVENUE
Practice Address - Street 2:
Practice Address - City:EAGLES MERE
Practice Address - State:PA
Practice Address - Zip Code:17731
Practice Address - Country:US
Practice Address - Phone:215-266-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037156E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice