Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | E5829 | TX |
N | 208D00000X | General Practice Physician | E5829 | TX |
NPI | 1255381794 |
---|---|
Provider Name | Raymond C Lewandowski |
First Address | Richmond, VA 23298-5048 |
Second Address | Richmond, VA 23298-5048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 17/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170391003 | (05) | TX |
8K6382 | BC/BS (01) | TX |
C18379 | (02) | TX |