Provider Demographics
NPI:1821167933
Name:WORRELL, LEWIT (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIT
Middle Name:
Last Name:WORRELL
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:PO BOX 2728
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-8728
Mailing Address - Country:US
Mailing Address - Phone:909-592-2078
Mailing Address - Fax:909-592-0279
Practice Address - Street 1:1334 W COVINA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3211
Practice Address - Country:US
Practice Address - Phone:909-599-6611
Practice Address - Fax:909-599-8390
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067787207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH64794Medicare UPIN