Provider Demographics
NPI:1649506270
Name:LEWIS, JUSTIN JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1010 LIBERTY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7949
Mailing Address - Country:US
Mailing Address - Phone:410-795-2155
Mailing Address - Fax:410-795-2154
Practice Address - Street 1:1010 LIBERTY RD
Practice Address - Street 2:STE 100
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-7949
Practice Address - Country:US
Practice Address - Phone:410-795-2155
Practice Address - Fax:410-795-2154
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3397213ES0103X
MD01503213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217626Y6RMedicare PIN