Provider Demographics
NPI:1811082241
Name:BARTLES, LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:BARTLES
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 1:7109 ANCHORAGE LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-283-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-03-12
Deactivation Date:2013-01-07
Deactivation Code:
Reactivation Date:2013-03-12
Provider Licenses
StateLicense IDTaxonomies
NC16246207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913594Medicaid
SCN16244Medicaid
NC8913594Medicaid
NCC82435Medicare UPIN