Provider Demographics
NPI:1629121033
Name:LEWIS, RODNEY PAUL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:PAUL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1234 TURKEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-4106
Mailing Address - Country:US
Mailing Address - Phone:410-212-4780
Mailing Address - Fax:
Practice Address - Street 1:15001 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6352
Practice Address - Country:US
Practice Address - Phone:410-212-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR119686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered