Organization
ROGER A LEWIS
Active
Other names
Cranberry Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
NORMA KEIM (OFFICE MANAGER)
(304) 789-2457
Entity
Organization
Contact information
Practice address
603B W STATE AVE, TERRA ALTA, WV 26764-1223
(304) 789-2457
(304) 789-6812
Mailing address
603B W STATE AVE, TERRA ALTA, WV 26764-1223
(304) 789-2457
(304) 789-6812
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12705
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0201807000
—
WV
01
—
CM7276
MEDICARE RAILROAD
WV
Enumeration date
03/20/2007
Last updated
02/08/2010
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