Provider Demographics
NPI:1508864273
Name:SUSKIEWICZ, LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:SUSKIEWICZ
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 1:5510 ALMA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-4012
Mailing Address - Country:US
Mailing Address - Phone:703-642-5990
Mailing Address - Fax:703-642-5003
Practice Address - Street 1:DEPT. 6029
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20042-0001
Practice Address - Country:US
Practice Address - Phone:703-642-5990
Practice Address - Fax:703-642-5003
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
144512OtherONE HEALTH PLAN/GREAT WST
P10011OtherNCPPO
4092115OtherAETNA PPO
4556-0008OtherCAREFIRST BCBS
723588OtherFIRST HEALTH/AFFORDABLE
0403505OtherUNITED HEALTHCARE - MIDAT
257638OtherALLIANCE/MAMSI
461901OtherAETNA HMO
5325453-026OtherCIGNA
0400439OtherUNITED HEALTHCARE - VA
224016OtherANTHEM/TRIGON
723588OtherFIRST HEALTH/AFFORDABLE
224016OtherANTHEM/TRIGON