Provider Demographics
NPI:1760466759
Name:LEWIS, LUANNE KEM (MD)
Entity type:Individual
Prefix:
First Name:LUANNE
Middle Name:KEM
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 1:7525 TIDEWATER DR STE 19
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3700
Mailing Address - Country:US
Mailing Address - Phone:757-330-0150
Mailing Address - Fax:877-487-3044
Practice Address - Street 1:7525 TIDEWATER DR STE 19
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3700
Practice Address - Country:US
Practice Address - Phone:757-330-0150
Practice Address - Fax:877-487-3044
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA119521OtherANTHEM PROVIDER NUMBER
VA5878217Medicaid
VA74903OtherOPTIMA HEALTH PROVIDER NO
VA000231195BDOtherHUMANA HEALTH PLAN
VAC47013Medicare UPIN
VA119521OtherANTHEM PROVIDER NUMBER