Individual
SANDRA J LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4004 MACCORKLE AVE SE, SUITE 1A, CHARLESTON, WV 25304-1672
(304) 926-0172
Mailing address
100 WOODSCAPE WAY, SCOTT DEPOT, WV 25560-9322
(304) 760-0447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18980
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054964000
—
WV
Enumeration date
09/27/2006
Last updated
07/08/2007
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