Provider Demographics
NPI:1326035072
Name:LEWIS, MARY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1303 AZALEA CT
Mailing Address - Street 2:STE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5765
Mailing Address - Country:US
Mailing Address - Phone:843-692-0570
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2016-09-13
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Provider Licenses
StateLicense IDTaxonomies
SC267022085R0202X, 2085B0100X, 2085D0003X, 2085U0001X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0001X, 2085R0205X, 2085R0203X, 207U00000X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890067F4OtherNC MEDICAID
SC154758900OtherUS DEPT OF LABOR
SCP00116458OtherRAILROAD MEDICARE
SC570525838OtherSTANDARD TAX ID
NC067F4OtherBCBS OF NC
SC267026Medicaid
SCD4050OtherMEDCOST
SC154758900OtherFEDERAL BLACK LUNG
SCD4050OtherMEDCOST
SC267026Medicaid