Provider Demographics
NPI:1679589550
Name:LEWIS, THOMAS WALTER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WALTER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BELMONT AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7109
Mailing Address - Country:US
Mailing Address - Phone:802-257-1770
Mailing Address - Fax:802-257-4148
Practice Address - Street 1:19 BELMONT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7109
Practice Address - Country:US
Practice Address - Phone:802-257-1770
Practice Address - Fax:802-257-4148
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420004485207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine