Provider Demographics
NPI:1972589547
Name:LEWIS SEWELL, ANITA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MARIE
Last Name:LEWIS SEWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-0003
Mailing Address - Country:US
Mailing Address - Phone:419-350-2411
Mailing Address - Fax:
Practice Address - Street 1:1323 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6714
Practice Address - Country:US
Practice Address - Phone:419-350-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066407L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0919788Medicaid
OHF99129Medicare UPIN