Provider Demographics
NPI:1386640712
Name:LEWISH, GREGORY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAVID
Last Name:LEWISH
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 1:2 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2519
Mailing Address - Country:US
Mailing Address - Phone:585-473-4844
Mailing Address - Fax:
Practice Address - Street 1:2211 LYELL AVE
Practice Address - Street 2:STE 107
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5743
Practice Address - Country:US
Practice Address - Phone:585-429-6440
Practice Address - Fax:429-585-6661
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156391-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00796763Medicaid
NY00796763Medicaid
NYDD4071Medicare ID - Type Unspecified