Provider Demographics
NPI:1609866516
Name:LEWANDROWSKI, KENT BALANIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:BALANIS
Last Name:LEWANDROWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 5 PATHOLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2275
Practice Address - Fax:617-726-3256
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA74448207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11566OtherBCBS MA
MA3085350Medicaid
MA074448OtherTUFTS HEALTH PLAN
MA074448OtherTUFTS HEALTH PLAN
MAJ11566Medicare ID - Type Unspecified