Provider Demographics
NPI:1700849056
Name:LEWIS, DANIELLE SIMON (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SIMON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 NATIONWIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-200-3908
Practice Address - Fax:866-617-8273
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
460051OtherBCBS
H38866Medicare UPIN
VVH966AMedicare PIN
VAP00346493OtherMEDICARE RAILROAD CARRIER
VA010207M68Medicare PIN
110008373Medicare ID - Type Unspecified
VA010259029Medicaid