Provider Demographics
NPI:1962456921
Name:LEWIS, CAROL T (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:T
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 1:593 EDDY ST
Mailing Address - Street 2:HASBRO 122
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-6484
Mailing Address - Fax:401-444-6378
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:HASBRO LOWER LEVEL
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-3850
Practice Address - Fax:401-444-3870
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI06400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7010293Medicaid
RI007010293Medicare PIN
RI7010293Medicaid