Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0024178384 | VA |
NPI | 1275170417 |
---|---|
Provider Name | Carlita T Lewis |
First Address | Richmond, VA 23221-2601 |
Second Address | Richmond, VA 23221-2601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2019 |
Last Update Date | 29/04/2021 |