Provider Demographics
NPI:1487677522
Name:LEWIS, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 665
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5167
Mailing Address - Fax:585-756-4721
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 665
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5167
Practice Address - Fax:585-756-4721
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY109332207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D78337Medicare UPIN