Provider Demographics
NPI:1861602930
Name:LEWIS, SHAROL A (MD)
Entity type:Individual
Prefix:DR
First Name:SHAROL
Middle Name:A
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:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-0539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 PENN PLZ E
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2200
Practice Address - Country:US
Practice Address - Phone:973-466-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-07-18
Deactivation Date:2010-07-02
Deactivation Code:
Reactivation Date:2011-07-08
Provider Licenses
StateLicense IDTaxonomies
NY174405-1207V00000X
NJ25MA05432600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology