Provider Demographics
NPI:1942289566
Name:LEWIS, STEPHEN FRASER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRASER
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 1:2300 COMPUTER RD
Mailing Address - Street 2:EXECUTIVE MEWS, SUITE H43
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1752
Mailing Address - Country:US
Mailing Address - Phone:215-659-3500
Mailing Address - Fax:215-659-3556
Practice Address - Street 1:2300 COMPUTER RD
Practice Address - Street 2:EXECUTIVE MEWS, SUITE H43
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1752
Practice Address - Country:US
Practice Address - Phone:215-659-3500
Practice Address - Fax:215-659-3556
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049894L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA745048OtherHIGHMARK BLUE SHIELD
PA745048OtherHIGHMARK BLUE SHIELD