Provider Demographics
NPI:1144328535
Name:LEWIS, LYDIA DEE (MD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:DEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:4845 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3943
Practice Address - Country:US
Practice Address - Phone:225-761-5200
Practice Address - Fax:225-754-5063
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15313R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA841703313OtherBENEFIT MANAGEMENT
LA841703313OtherAETNA
LAH3655OtherBLUE CROSS BLUE SHIELD
LA841703313OtherCIGNA
LA841703313OtherHUMANA
LA1175064Medicaid
LA841703313OtherUNITED HEALTH CARE
MS09823702Medicaid
LA841703313OtherSTATE GROUP
LA841703313OtherFARA
LA841703313OtherCOVENTRY
LA841703313OtherTRICARE
MS09823702Medicaid
LA841703313OtherFARA
LA841703313OtherAETNA