Provider Demographics
NPI:1689757452
Name:LEWIS PHYSICIAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:LEWIS PHYSICIAL MEDICINE ASSOCIATES PA
Other - Org Name:SAME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-644-5133
Mailing Address - Street 1:166 S RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6928
Mailing Address - Country:US
Mailing Address - Phone:603-644-5133
Mailing Address - Fax:603-644-3086
Practice Address - Street 1:166 S RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6928
Practice Address - Country:US
Practice Address - Phone:603-644-5133
Practice Address - Fax:603-644-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000190Medicaid
NH1700869096OtherNPI
NH1881659662OtherNPI
NH1609805076OtherNPI
NH80000190Medicaid
NH1700869096OtherNPI
NHLERE0190Medicare ID - Type Unspecified
NHG28730Medicare UPIN