Provider Demographics
NPI:1457444945
Name:LEWIS, ALLEN T (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:T
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 1:1090 BEECHER XING N
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4566
Mailing Address - Country:US
Mailing Address - Phone:614-245-4750
Mailing Address - Fax:614-855-8820
Practice Address - Street 1:5925 CLEVELAND AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2209
Practice Address - Country:US
Practice Address - Phone:614-245-4750
Practice Address - Fax:614-855-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109880208000000X
OH35.095160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F69365Medicare UPIN