Provider Demographics
NPI:1851362594
Name:LEWIS, PAULETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:31 ARNOT RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8533
Practice Address - Country:US
Practice Address - Phone:607-795-5100
Practice Address - Fax:076-795-5195
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207068-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8362OtherRR MEDICARE
PA0019371020001Medicaid
NY110247537OtherRR MEDICARE - PIN
NY01761302Medicaid
H55583Medicare UPIN
NYDD4564Medicare ID - Type Unspecified