Provider Demographics
NPI:1003873068
Name:MAHRAN, LEWIS A (DO)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:A
Last Name:MAHRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1186
Mailing Address - Country:US
Mailing Address - Phone:937-548-9680
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1186
Practice Address - Country:US
Practice Address - Phone:937-548-9680
Practice Address - Fax:937-548-2087
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015090Medicaid
OH2015090Medicaid
OHH410100Medicare PIN
G54125Medicare UPIN