Provider Demographics
NPI:1881654614
Name:LEWIS, BERNADINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BERNADINE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1320
Mailing Address - Country:US
Mailing Address - Phone:267-975-9313
Mailing Address - Fax:610-259-1873
Practice Address - Street 1:208 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1320
Practice Address - Country:US
Practice Address - Phone:267-975-9313
Practice Address - Fax:610-259-1873
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00365500363A00000X
PAMA050628-L207Q00000X
PAMA050682363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881654614OtherNPI