Provider Demographics
NPI:1639619224
Name:LEWIS PRIMARY CARE, P.A.
Entity Type:Organization
Organization Name:LEWIS PRIMARY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:443-978-7383
Mailing Address - Street 1:1324 BELMONT AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4584
Mailing Address - Country:US
Mailing Address - Phone:443-978-7383
Mailing Address - Fax:443-978-7598
Practice Address - Street 1:1324 BELMONT AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4584
Practice Address - Country:US
Practice Address - Phone:443-978-7383
Practice Address - Fax:443-978-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty