Provider Demographics
NPI:1255381794
Name:LEWANDOWSKI, RAYMOND C (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:LEWANDOWSKI
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 1:1101 E MARSHALL ST
Mailing Address - Street 2:PO 980033
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5048
Mailing Address - Country:US
Mailing Address - Phone:804-628-4517
Mailing Address - Fax:804-827-1124
Practice Address - Street 1:1101 E MARSHALL ST
Practice Address - Street 2:PO 980033
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5048
Practice Address - Country:US
Practice Address - Phone:804-628-4517
Practice Address - Fax:804-827-1124
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5829207SG0201X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6382OtherBC/BS
TX170391003Medicaid
TX170391003Medicaid
TXC18379Medicare UPIN