Individual
MARYELLEN CATHLEEN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
216 SEYMOUR ST, SYRACUSE, NY 13204-3208
(315) 703-2600
(315) 703-2601
Mailing address
321 GIFFORD ST, SYRACUSE, NY 13204-3201
(315) 703-2600
(315) 703-2601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
257779
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03242371
—
NY
Enumeration date
05/15/2007
Last updated
10/17/2014
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