Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101238901 | VA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 0101238901 | VA |
NPI | 1215992896 |
---|---|
Provider Name | Edward Josiah Lewis |
First Address | Lynchburg, VA 24501-2184 |
Second Address | Lynchburg, VA 24501-2184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215992896 | (05) | VA |
I43138 | (02) |