Provider Demographics
NPI:1811097348
Name:LEWIS, ROBERT LEE II (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:LEWIS
Suffix:II
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 1:1208 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8708
Mailing Address - Country:US
Mailing Address - Phone:304-757-5747
Mailing Address - Fax:304-757-5744
Practice Address - Street 1:1200 HOSPITAL DR
Practice Address - Street 2:SUITE 1208
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8706
Practice Address - Country:US
Practice Address - Phone:304-757-5455
Practice Address - Fax:304-757-5467
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV212432084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721671OtherBCBS
WV2006799000Medicaid
OH2454544Medicaid
WVLE4127401Medicare PIN