Provider Demographics
NPI:1295267151
Name:LEWIS, KATHERINE P (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEWIS
Other - Last Name:KLUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11125 ROCKVILLE PIKE STE 307
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:410-430-1655
Mailing Address - Fax:
Practice Address - Street 1:11125 ROCKVILLE PIKE STE 307
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:410-430-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051396208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics