Provider Demographics
NPI:1346206604
Name:LEWIS, LAWRENCE A (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:LEWIS
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:629 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1821
Practice Address - Country:US
Practice Address - Phone:419-562-4677
Practice Address - Fax:419-862-0987
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068697L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1080002Medicaid
OH930116138OtherRR MEDICARE MARION
OH000000246458OtherBCBS MARION
OHP00216224OtherMEDICARE RAIL ROAD/BUCYRUS
OH000000316694OtherANTHEM/BCBS
000000384391OtherBCBS GALION
P00320500OtherRR NMEDICARE
000000384391OtherBCBS GALION
OH000000246458OtherBCBS MARION
OH000000316694OtherANTHEM/BCBS
LE0792076Medicare PIN