Provider Demographics
NPI:1750325049
Name:LEWIS-PRINCE, MARNA T (MD)
Entity Type:Individual
Prefix:
First Name:MARNA
Middle Name:T
Last Name:LEWIS-PRINCE
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 1:7101 JAHNKE RD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4017
Mailing Address - Country:US
Mailing Address - Phone:804-327-4046
Mailing Address - Fax:804-327-4047
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 611
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-327-4046
Practice Address - Fax:804-327-4047
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237459208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010164664Medicaid
NC5900879Medicaid
NC5900879Medicaid
VA016567V16Medicare PIN