Provider Demographics
NPI:1508831892
Name:LEWIS, DAVID DUBRUTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUBRUTZ
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 1:501 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3565
Mailing Address - Country:US
Mailing Address - Phone:252-975-2667
Mailing Address - Fax:
Practice Address - Street 1:501 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3565
Practice Address - Country:US
Practice Address - Phone:252-975-2667
Practice Address - Fax:252-975-2507
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951803Medicaid
NC02723OtherBCBS
NC2192026FMedicare PIN