Provider Demographics
NPI:1467488049
Name:LEWANDA, AMY F (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:F
Last Name:LEWANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4621
Mailing Address - Country:US
Mailing Address - Phone:703-970-2600
Mailing Address - Fax:703-970-2620
Practice Address - Street 1:8505 ARLINGTON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-970-2600
Practice Address - Fax:703-970-2620
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101051757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF82794Medicare UPIN
DC000M81I99Medicare PIN