Provider Demographics
NPI:1891772604
Name:LEWIS, DONALD RYAN JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RYAN
Last Name:LEWIS
Suffix:JR
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 910
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:3448 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2906
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.0805542085R0202X
MDDO0413462085R0202X
KY330322085R0202X
WV189792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018739Medicaid
KYP00766025OtherRR MEDICARE (KY)
OH000000196333OtherUNISON
KY50007262OtherPASSPORT
WV550493376OtherWORKMANS COMP
KY6494193300Medicaid
WV300081882OtherRR MEDICARE (WV)
5389160OtherAETNA
001718777OtherMTN STATE BCBS
WV012206000Medicaid
OH000000196333OtherUNISON
5389160OtherAETNA
WV300081882OtherRR MEDICARE (WV)
G07475Medicare UPIN