Provider Demographics
NPI:1396728804
Name:LEWIS, ROY SHELDON (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:SHELDON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:144 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-0162
Practice Address - Country:US
Practice Address - Phone:704-658-0595
Practice Address - Fax:704-658-0916
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01689207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01650118OtherMEDICARE-RAILROAD
NC1699COtherBCBSNC
SC1216263OtherWELLCARE OF SC
6239215OtherCIGNA
TX117783401Medicaid
SCQ0168AMedicaid
SCQ0168AMedicaid
SCQ0168AMedicaid
NCNC6495AMedicare PIN