Provider Demographics
NPI:1629833355
Name:LEWIS, ELIZJAH
Entity Type:Individual
Prefix:
First Name:ELIZJAH
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BALAMOR CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4433
Mailing Address - Country:US
Mailing Address - Phone:302-465-6653
Mailing Address - Fax:
Practice Address - Street 1:118 BALAMOR CT
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-4433
Practice Address - Country:US
Practice Address - Phone:302-465-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)