Provider Demographics
NPI:1497747968
Name:LEWIS, JEREMIAH JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JAMES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:JAMES
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:372 DANBURY RD STE 197
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2523
Mailing Address - Country:US
Mailing Address - Phone:203-276-3366
Mailing Address - Fax:203-276-3367
Practice Address - Street 1:372 DANBURY RD STE 197
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2523
Practice Address - Country:US
Practice Address - Phone:203-966-6305
Practice Address - Fax:203-966-4618
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1497747968Medicaid
CT1497747968Medicaid
CT001328956Medicaid