Provider Demographics
NPI:1538262670
Name:LEWIS, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2446
Mailing Address - Country:US
Mailing Address - Phone:978-774-2555
Mailing Address - Fax:978-774-8715
Practice Address - Street 1:99 CONIFER HILL DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1193
Practice Address - Country:US
Practice Address - Phone:978-774-2555
Practice Address - Fax:978-774-8715
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-05-21
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Provider Licenses
StateLicense IDTaxonomies
MA44331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2070561Medicaid
MA2070561Medicaid