Provider Demographics
NPI:1396749669
Name:BATEMAN, LEWIS LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:LEE
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:125 OAKLAND AVE SUITE 205
Mailing Address - Street 2:MATHER PRIMARY CARE
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-686-2523
Mailing Address - Fax:631-686-2525
Practice Address - Street 1:125 OAKLAND AVE SUITE 205
Practice Address - Street 2:MATHER PRIMARY CARE
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-686-2523
Practice Address - Fax:631-686-2525
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2013-10-24
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Provider Licenses
StateLicense IDTaxonomies
NY124006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00349642Medicaid
NY00349642Medicaid
NY304831Medicare PIN