Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 9415 | WV |
N | 207RN0300X | Nephrologist | 9415 | WV |
NPI | 1790770386 |
---|---|
Provider Name | Dr. Mary Lou Lewis |
First Address | Charleston, WV 25312-9460 |
Second Address | Charleston, WV 25301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AL1382299 | DEA NUMBER (01) | WV |