Provider Demographics
NPI:1801810619
Name:LEWIS, KERRY RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:RANDALL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7182
Mailing Address - Country:US
Mailing Address - Phone:703-273-3613
Mailing Address - Fax:703-273-9676
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-273-3613
Practice Address - Fax:703-273-9676
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101028949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine