Provider Demographics
NPI:1346397304
Name:LEWIS, DAVID OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:OWEN
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 1:828 TURNER ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0647
Mailing Address - Country:US
Mailing Address - Phone:276-632-8549
Mailing Address - Fax:
Practice Address - Street 1:18688 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1559
Practice Address - Country:US
Practice Address - Phone:276-694-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023990207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC39-17467OtherUNITED HEALTH CARE
NC13725COtherBLUE CROSS BLUE SHIELD
NC6101OtherPARTNERS
NC5900678Medicaid
NC2074610Medicare PIN
NCP00449568Medicare PIN