Provider Demographics
NPI:1457444945
Name:LEWIS, ALLEN T (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:T
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 1:7676 SMOKE RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-9067
Mailing Address - Country:US
Mailing Address - Phone:614-259-3760
Mailing Address - Fax:866-644-9029
Practice Address - Street 1:7676 SMOKE RD SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9067
Practice Address - Country:US
Practice Address - Phone:614-245-4750
Practice Address - Fax:614-855-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095160208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F69365Medicare UPIN