Provider Demographics
NPI:1508843442
Name:LEWIS, DANTE NEISONE (MD)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:NEISONE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 W WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3706
Mailing Address - Country:US
Mailing Address - Phone:336-228-8316
Mailing Address - Fax:336-227-9750
Practice Address - Street 1:3940 ARROWHEAD BLVD STE 270
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7637
Practice Address - Country:US
Practice Address - Phone:919-563-0202
Practice Address - Fax:919-563-0242
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30392OtherSC MEDICAL LICENSE
SC4001444OtherCIGNA
SC9630227OtherAETNA
SC20069023OtherSELECT HEALTH
SCAA23878552OtherMEDICARE PTAN
NC2019-00846OtherNC MEDICAL LICENSE
SC303923Medicaid
SC18500OtherEVOLUTIONS
NC5908146Medicaid