Provider Demographics
NPI:1427027895
Name:LEWIS, CLEMENTINA JOVIONO (MD)
Entity Type:Individual
Prefix:
First Name:CLEMENTINA
Middle Name:JOVIONO
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1110 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1905
Mailing Address - Country:US
Mailing Address - Phone:716-923-4380
Mailing Address - Fax:716-923-4384
Practice Address - Street 1:4979 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2547
Practice Address - Country:US
Practice Address - Phone:716-923-4380
Practice Address - Fax:716-923-4384
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000983082Medicaid
NYBA0264Medicare PIN
NYRA3009Medicare PIN
NYD76873Medicare UPIN