Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1034 | MD |
Y | 103TC0700X | Clinical Psychologist | 1034 | MD |
NPI | 1013106863 |
---|---|
Provider Name | Dr. James Edwin Lewis |
First Address | Chaptico, MD 20621-0217 |
Second Address | Chaptico, MD 20621-0217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/10/2007 |