Provider Demographics
NPI:1861488538
Name:LEWIS, RAYMOND E (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
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 1:105 VINE CREST CT #1000
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-8031
Mailing Address - Country:US
Mailing Address - Phone:864-725-3350
Mailing Address - Fax:864-725-3351
Practice Address - Street 1:105 VINE CREST CT #1000
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-725-3350
Practice Address - Fax:864-725-3351
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16780207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL7748Medicaid
F58904Medicare UPIN
SCTL7748Medicaid