Provider Demographics
NPI:1841282555
Name:EBERLY, LEWIS BAKER (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:BAKER
Last Name:EBERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 N BEAUREGARD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1723
Mailing Address - Country:US
Mailing Address - Phone:703-845-1500
Mailing Address - Fax:703-845-1300
Practice Address - Street 1:1500 N BEAUREGARD STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1715
Practice Address - Country:US
Practice Address - Phone:703-845-1500
Practice Address - Fax:703-845-1300
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010453842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007111975Medicaid
VA000L17C62Medicare ID - Type Unspecified
VA007111975Medicaid