Individual
WALLACE E LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18682 NORTHUMBERLAND HWY, REEDVILLE, VA 22539-3411
(804) 453-4537
(804) 453-4713
Mailing address
PO BOX 1328, KILMARNOCK, VA 22482-1328
(804) 435-8570
(804) 435-8037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101028388
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080133503
RAILROAD
VA
05
—
1114981966
—
VA
Enumeration date
04/17/2006
Last updated
01/08/2013
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