Provider Demographics
NPI:1841316254
Name:WILLS, STEPHEN LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:WILLS
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 1:102 IRVING ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2921
Mailing Address - Country:US
Mailing Address - Phone:202-877-1000
Mailing Address - Fax:202-882-8434
Practice Address - Street 1:102 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2921
Practice Address - Country:US
Practice Address - Phone:202-877-1000
Practice Address - Fax:202-882-8434
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15363208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
5460-0022OtherBS NCA 1500
MD561071100Medicaid
DC024027200Medicaid
5421827003OtherCIGNA
DCA0015363OtherBC NCA UB 92
422791-01OtherBS OF MARYLAND
4270331OtherAETNA NON-HMO
250008028OtherRAILROAD MEDICARE
110883OtherKAISER
320227OtherMAMSI
495032OtherNCPPO
422791-01OtherBS OF MARYLAND
DCA0015363OtherBC NCA UB 92