Provider Demographics
NPI:1275594475
Name:LEWIS, MAHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3190 N MCMULLEN BOOTH RD
Mailing Address - Street 2:STE 203
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2013
Mailing Address - Country:US
Mailing Address - Phone:727-723-1910
Mailing Address - Fax:727-723-1920
Practice Address - Street 1:3190 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2007
Practice Address - Country:US
Practice Address - Phone:727-723-1910
Practice Address - Fax:727-723-1920
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME74378207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254935201Medicaid
FL254935201Medicaid
FLF77604Medicare UPIN