Provider Demographics
NPI:1407282296
Name:LEWIS, ROSHAUD L (RMP)
Entity Type:Individual
Prefix:
First Name:ROSHAUD
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3071
Mailing Address - Country:US
Mailing Address - Phone:240-244-6005
Mailing Address - Fax:
Practice Address - Street 1:8969 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4203
Practice Address - Country:US
Practice Address - Phone:301-868-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist