Provider Demographics
NPI:1851473995
Name:LEWIS, MARSHALL EDWARDS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:EDWARDS
Last Name:LEWIS
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 1:10755 SCRIPPS RANCH BLVD
Mailing Address - Street 2:#172
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2467
Mailing Address - Country:US
Mailing Address - Phone:209-505-4525
Mailing Address - Fax:
Practice Address - Street 1:10755 SCRIPPS RANCH BLVD
Practice Address - Street 2:#172
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2467
Practice Address - Country:US
Practice Address - Phone:209-505-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG475822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92731Medicare UPIN