Provider Demographics
NPI:1528027620
Name:LEWIS, VIRGINIA P
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5308
Mailing Address - Country:US
Mailing Address - Phone:318-322-3535
Mailing Address - Fax:318-322-3560
Practice Address - Street 1:324 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5308
Practice Address - Country:US
Practice Address - Phone:318-322-3535
Practice Address - Fax:318-322-3560
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024992207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1423238Medicaid
I03808Medicare UPIN
LA4F755CJ49Medicare PIN