Individual
GINA MARIE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
3640 MAIN ST, SPRINGFIELD, MA 01107-1145
(413) 328-0617
Mailing address
51 VAN DEENE AVE, APT O1, WEST SPRINGFIELD, MA 01089-3218
(413) 328-0617
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA4449
MA
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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