Provider Demographics
NPI:1942392592
Name:LEWIS, LINDA DONELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DONELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 W 168TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2699
Mailing Address - Country:US
Mailing Address - Phone:212-305-5246
Mailing Address - Fax:212-305-1679
Practice Address - Street 1:710 W 168TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2699
Practice Address - Country:US
Practice Address - Phone:212-305-5246
Practice Address - Fax:212-305-1679
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1040302084N0400X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00180745Medicaid
NYB79636Medicare UPIN