Provider Demographics
NPI:1578605879
Name:LEWIS, ANTOINETTE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:MARIA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 EYE STREET NW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-887-8144
Mailing Address - Fax:202-887-8166
Practice Address - Street 1:1712 EYE STREET NW
Practice Address - Street 2:SUITE 310
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-887-8144
Practice Address - Fax:202-887-8166
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC178372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G5140001OtherBLUE CROSS BLUE SHIELD
513210OtherNCPPO
G5140001OtherBLUE CROSS BLUE SHIELD