Provider Demographics
NPI:1942234489
Name:LEWIS, DWIGHT D (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:D
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 1:3125 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1305
Mailing Address - Country:US
Mailing Address - Phone:716-834-1455
Mailing Address - Fax:716-834-1456
Practice Address - Street 1:3125 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1305
Practice Address - Country:US
Practice Address - Phone:716-834-1455
Practice Address - Fax:716-834-1456
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592474Medicaid
NY000523295002OtherBLUE CROSS-BLU SHIELD WNY
NY429874OtherWELLCARE
NY000523295006OtherBLUE SHIELD
NY161589460OtherUNITED HEALTH CARE
NY930129182OtherRAILROAD MEDICARE
NY00010103901OtherUNIVERA
NY0406468OtherINDEPENDENT HEALTH
NYF77879Medicare UPIN
NY01592474Medicaid