Provider Demographics
NPI:1760445332
Name:LEWKOW, LAWRENCE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:LEWKOW
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 1:7202 GLEN FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-0134
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:6130 HARBOURSIDE CENTRE LOOP
Practice Address - Street 2:STE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2170
Practice Address - Country:US
Practice Address - Phone:804-378-0394
Practice Address - Fax:804-739-7649
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049920207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01120OtherMEDICARE GROUP PTAN
VA237401OtherANTHEM BCBS VA
VA006004628Medicaid
VA60066OtherCOVENTRY SOUTHERN HEALTH SERVICES
VA110141099OtherRR MEDICARE
VAA74343Medicare UPIN
VA60066OtherCOVENTRY SOUTHERN HEALTH SERVICES