Individual
WENDELL R LEWIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
45 HUNT CLUB DR, RIDGELEY, WV 26753-7567
(304) 726-4501
(304) 726-4051
Mailing address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(304) 598-1200
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
01323
WV
363A00000X
Physician Assistant
Primary
01323
WV
363A00000X
Physician Assistant
C05465
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110002558
LICENSE
VA
01
—
01323
WEST VIRGINIA LICENSE
WV
01
—
MA053081
PENNSYLVANIA PA LICENSE
PA
Enumeration date
08/17/2007
Last updated
07/13/2020
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