Provider Demographics
NPI:1609218759
Name:LEWIS, DAVID EVERETT (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EVERETT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1423
Mailing Address - Country:US
Mailing Address - Phone:215-945-1800
Mailing Address - Fax:215-945-0569
Practice Address - Street 1:2346 TRENTON RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1423
Practice Address - Country:US
Practice Address - Phone:215-945-1800
Practice Address - Fax:215-945-0569
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB09743300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ535285ZGH1Medicare PIN