Provider Demographics
NPI:1013700640
Name:LEWIS, NOAH DANIEL HURST (MD)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:DANIEL HURST
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 1:21 CHARLES ST
Mailing Address - Street 2:APT. 604
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141
Mailing Address - Country:US
Mailing Address - Phone:857-270-4790
Mailing Address - Fax:956-625-5591
Practice Address - Street 1:55 FRUIT ST.
Practice Address - Street 2:YAWHAY OUTPATIENT CENTER -5B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-7117
Practice Address - Fax:617-643-7222
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3017835390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program