Provider Demographics
NPI:1275791147
Name:LEWIS, VINCENT WALTER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:WALTER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:951 MOUNT HERMON RD STE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5159
Mailing Address - Country:US
Mailing Address - Phone:410-749-4400
Mailing Address - Fax:410-749-0847
Practice Address - Street 1:1324 BELMONT AVE STE 103
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4543
Practice Address - Country:US
Practice Address - Phone:443-978-7383
Practice Address - Fax:443-978-7598
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC03755363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003M138173ZBTEMedicare UPIN